Diagnostic challenges of bronchiectasis

Abstract

Bronchiectasis is a condition of increasing incidence and prevalence around the world.Many different diseases have been associated with bronchiectasis, and their treatment can differ widely. Recent guidelines have helped to approach aetiological diagnosis but it is still a complex process. Identifying the cause of the bronchiectasis may determine a change in the treatment of a large group of subjects. That is one of the main reasons why the aetiological diagnosis is crucial in the proper management of bronchiectasis patients.Postinfectious bronchiectasis is the most frequent entity among different studies, but a high percentage of cases still remain without a clear aetiology. Bronchiectasis related to allergic bronchopulmonary aspergillosis (ABPA), immunodeficiencies with antibody production deficiency, primary ciliary dyskinesia, cystic fibrosis and alpha-1-antitrypsin deficiency, among others, require a specific management that may improve quality of life and prognosis in a large group of individuals. Therefore, the aim of this article is to review the main bronchiectasis related diseases and to simplify the aetiological diagnosis, in order to improve the management of bronchiectasis patients, especially in those where a specific treatment is available.

Bronchiectasis: Treatment decisions for pulmonary exacerbations and their prevention

“…There are no guidelines to assess efficacy of eradication therapy, although studies of the impact of antibiotics in bronchiectasis have reported pathogen eradication at the end of clinical trials (where eradication was a secondary endpoint), at next clinic review, at 3 and 12 months of follow‐up and where no Pseudomonas was cultured in three sputum samples over 6 months after eradication . It would be pragmatic to assess sputum culture (at least once) at the next clinic appointment after antibiotics are completed and to assess regularly in the year following.…”

“…A recent study has evaluated the role of anti‐ P. aeruginosa IgG antibodies . Key results from this study demonstrated that a positive Pa‐IgG antibody test had high sensitivity (95%) and moderate specificity (74%) in patients with chronic P. aeruginosa infection.…”

“…Four recent studies specifically address the impact of eradication of P. aeruginosa infection. The studies from centres in Spain and the UK ranged from 30 to 64 participants and involved a range of regimens and associated with eradication of~50-60% at~6-12 months after completion of therapy [76][77][78][79] (Table 1). It is however not clear from longitudinal studies how many patients spontaneously clear P. aeruginosa over time.…”

The formation and function of tertiary lymphoid follicles in chronic pulmonary inflammation

“…Certainly there appears to be an underappreciated overlap in the pathogenic changes across bronchiectasis and COPD. In addition, bronchiectasis can also occur in patients in COPD and is associated with an increased risk of mortality and morbidity in moderate to severe COPD . Studies investigating patient subsets with bronchiectasis and COPD could reveal the link between specific microbial signatures and lymphoid neogenesis in the respiratory tract.…”

New therapies for the prevention and treatment of exacerbations of bronchiectasis

“…Less frequent causes such as allergic bronchopulmonary aspergillosis, connective tissue disease, non-tuberculous mycobacterial disease and immunodeficiency must be identified and treated as they usually require a specific treatment not described below. (20)(21)(22)(23) Once the initial identification and treatment of underlying causes has been performed, the disease still presents individual "phenotypes". (24) Exacerbations of bronchiectasis typically presenting with a combination of increasing cough, sputum production, increasing sputum purulence, malaise, fever or worsening breathlessness.…”