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Feature Article

Bronchiectasis: a new dawn in diagnosis and treatment

KANISHKA RANGAMUWA, ROB G. STIRLING
OPEN ACCESS

Azithromycin is an important agent in the management of nontuberculous mycobacteria and as such should be avoided in those with previous nontuberculous mycobacteria isolates to avoid resistance concerns. A pretreatment ECG is recommended as azithromycin can be associated with proarrhythmogenic QT prolongation.

Exercise and rehabilitation

Reduced exercise capacity in bronchiectasis is likely to be due to sputum production, progressive airflow obstruction, chest hyperinflation and dyspnoea, altered respiratory mechanics, decreased skeletal muscle bulk and ongoing infection. Bronchodilator therapy and control of infection improve exercise capacity and functional level but these may be further augmented by exercise, such as that included in pulmonary rehabilitation programs. Exercise such as walking, cycling and trampolining can also lead to full lung inflation and contribute to effective expectoration and mucus clearance. Improved exercise capability appears to be linked with improved quality of life in patients with non-CF bronchiectasis and should be encouraged.

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Vaccination

Vaccination against pathogens known to trigger respiratory exacerbation and decrease respiratory tract infections has become standard practice in the care of children and adults with chronic lung disease, but there is little evidence to support this in patients with non-CF bronchiectasis. Nevertheless, clinical experience would recommend that both influenza and pneumococcal vaccinations be made available to all patients with established bronchiectasis.

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Conclusion

Bronchiectasis causes substantial morbidity, mortality and impairment in quality of life. The broader availability of high-quality HRCT scanning has seen a significant increase in diagnostic capture. The key to successful treatment lies in early diagnosis, a patient specific exercise and airway clearance regimen and the provision of a management plan for pathogen eradication and suppression with flexible responsiveness for acute exacerbations. Challenges for the future include better definition of disease mechanisms and the confirmation of evidence defining and improving of antibiotic, mucoactive and airway clearance strategies.     MT

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COMPETING INTERESTS: Dr Rangamuwa: None. Associate Professor Stirling has participated in pharmaceutical trials of inhaled antibiotics sponsored by Bayer and Zambon.

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Dr Rangamuwa is an Advanced Trainee in Respiratory Medicine and a Respiratory Registrar at The Alfred Hospital, Melbourne. Associate Professor Stirling is a Senior Specialist in Respiratory Medicine at The Alfred Hospital, Melbourne; and a Clinical Adjunct Associate Professor in the Department of Medicine, Monash University, Melbourne, Vic.