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Feature Article

Bronchiectasis: a new dawn in diagnosis and treatment

KANISHKA RANGAMUWA, ROB G. STIRLING

Figures

© DECADE3D/ISTOCKPHOTO.COM
© DECADE3D/ISTOCKPHOTO.COM

Abstract

Diagnosis of bronchiectasis has increased with broader availability of high-resolution CT scanning. Early diagnosis and development of a patient-specific exercise and airway clearance regimen and a pathogen eradication and suppression plan are key to successful treatment. Management can be shared by GPs in co-operation with a specialist respiratory physician and respiratory physiotherapist.

Key Points

  • Underdiagnosis of bronchiectasis has been a significant problem caused in part by clouding by coexisting respiratory comorbidities including chronic obstructive pulmonary disease and asthma.
  • High-resolution CT scanning is now widely available and is the gold standard diagnostic test.
  • Confirming a diagnosis of bronchiectasis enables the provision of disease-appropriate treatments and the rationalisation of potentially inappropriate treatments.
  • Exercise, airway clearance and mucoactive therapies all help reduce airway inflammatory burden, leading to reduced symptoms and exacerbations and improved quality of life.
  • Microbiological surveillance enables the identification of agents such as Pseudomonas aeruginosa and nontuberculous mycobacteria that have powerful negative impacts on symptoms, lung function, exacerbations and healthcare utilisation.
  • Antibiotics play a key role in the eradication of novel microbial isolates, immunomodulation, exacerbation management and long-term suppression of microbial colonisation in the airways.
  • GPs can share in tailoring a patient-specific management plan in co-operation with a specialist respiratory physician and respiratory physiotherapist.

Figures

© DECADE3D/ISTOCKPHOTO.COM
© DECADE3D/ISTOCKPHOTO.COM