Management of Bronchiectasis for the Community Respirologist

Abstract

Bronchiectasis is a common chronic lung disease that remains undertreated and under serviced, likely in part due to its heterogenous nature and diversity in clinical presentation. Bronchiectasis is characterized by the permanent dilation of the airways visible on radiographic imaging, characterized by decreased function of the mucociliary transport mechanism. This dysfunction leads to recurrent infections secondary to increased bacterial invasion and mucus accumulation. It is defined as a syndrome marked by chronic cough, sputum production, and repeated lower respiratory tract infections. Bronchiectasis is an important area of respiratory medicine given its increasing prevalence. It affects an estimated 566 individuals per 100,000, making it the third most common chronic airway disease, after chronic obstructive pulmonary disease and asthma. While it can develop in childhood, particularly during the pre-antibiotic era, it can occur at any age, with prevalence increasing with advancing age. This increase in prevalence may be secondary to greater awareness amongst healthcare professionals.   

Bronchiectasis is a treatable but rarely curable condition. Identifying and treating the underlying cause is recommended. Bronchiectasis can be caused by many underlying etiologies, including infectious, inflammatory, genetic, or immunological causes. Despite this wide range of etiologies, idiopathic bronchiectasis accounts for 32%–66% of all causes. Treatment goals include managing any underlying systemic conditions, preventing lung infections, and implementing chest physiotherapy. Surgery may be recommended for localized bronchiectasis with refractory infections and hemoptysis. This article will review the chronic management of bronchiectasis, with a focus on chest physiotherapy techniques and the use of inhaled antibiotics.