Bronchiectasis
Bronchiectasis is characterized by irreversible dilation of the bronchi due to chronic infection and inflammation. Patients experience chronic productive cough, recurrent exacerbations, and progressive lung damage. Etiologies include post-infectious injury, immune deficiency, CF, ABPA, and primary ciliary dyskinesia.
Symptoms
- Daily productive cough with large sputum volumes
- Dyspnea, wheezing, chest tightness
- Hemoptysis, fatigue, weight loss
- Recurrent respiratory infections/exacerbations
Diagnosis
- High-resolution CT (HRCT) showing bronchial dilation (signet ring sign), bronchial wall thickening, mucus plugging
- Sputum cultures (Pseudomonas, NTM, H. influenzae)
- Pulmonary function tests (obstructive or mixed pattern)
- Evaluate underlying cause: immunoglobulins, CF/primary ciliary dyskinesia testing, autoimmune markers, aspergillus IgE for ABPA
Treatment & Management
Airway Clearance
- Daily physiotherapy: oscillatory PEP devices, high-frequency chest wall oscillation, autogenic drainage
- Hypertonic saline or inhaled mannitol (where approved)
- Nebulized DNase not recommended in non-CF bronchiectasis
Pharmacotherapy
- Long-term macrolides (azithromycin) for frequent exacerbations (screen for NTM before starting)
- Inhaled antibiotics (tobramycin, aztreonam, colistin) for chronic Pseudomonas colonization
- Bronchodilators for concurrent airway obstruction
- Treat underlying conditions (ABPA with steroids/itraconazole; immune deficiency with IVIG)
Exacerbation Management
- Culture-guided antibiotics, often 14 days
- Systemic steroids rarely needed unless concurrent asthma/COPD
- Hydration, airway clearance intensification
Lifestyle
- Vaccinations (influenza, COVID-19, pneumococcal, RSV if eligible)
- Exercise/pulmonary rehab, weight maintenance
- Smoking cessation, manage GERD/aspiration
Living with Bronchiectasis
- Track sputum volume/color, airway clearance adherence, medications, cultures, and exacerbations
- Monitor lung function and oxygen saturation
- Plan travel with nebulizers, sterile supplies, medication backups
- Address mental health and fatigue; chronic cough affects social life
Complications
- Progressive lung function decline, respiratory failure
- Massive hemoptysis
- Pulmonary hypertension
- Frequent antibiotic exposure/resistance
Research & Future Directions
Emerging approaches target neutrophilic inflammation, biofilm disruption, and personalized microbiome monitoring.
Experimental & Emerging Treatments
- Neutrophil Elastase Inhibitors: Brensocatib (DPP1 inhibitor) reduces exacerbations by dampening neutrophil activation.
- Phage Therapy: Target persistent Pseudomonas/NTM biofilms.
- Inhaled Nitric Oxide Therapy: Investigated for antimicrobial and anti-inflammatory effects.
- Digital Adherence Devices: Track airway clearance and inhaled antibiotic use to optimize outcomes.
Track Bronchiectasis with Diagnoza.care
Own Your Airway Routine – Log airway clearance sessions, sputum characteristics, inhaled/oral meds, cultures, exacerbations, lung function, and clinic visits; capture side effects; and let the AI companion detect warning signs of infection or lapses in therapy.
Medical Disclaimer: Informational only. Partner with your pulmonologist/bronchiectasis clinic to tailor airway clearance, antibiotics, and monitoring for underlying etiologies.
Sources: European Respiratory Society, British Thoracic Society, American Thoracic Society