Bronchiectasis is a long-term lung disease that affects hundreds of thousands of people worldwide. Bronchiectasis is a persistent or progressive chronic debilitating disease characterized by permanent dilation of the bronchi due to irreversible damage to the elastic and muscular components of the bronchial wall (1). Symptoms can include breathlessness, frequent cough, sputum production and associated symptoms such as tiredness, fever, which can come with repeat chest infections. Diagnosis is usually via CT imaging alongside clinical history.
Bronchiectasis is historically regarded as a neutrophilic disease dominated by Pseudomonas, Haemophilus and Streptococcus infection usually.
The cause of disease progression is assumed to be the result of a complex interaction between chronic infection, inflammation, and impaired mucus clearance, which leads to structural changes in the lungs, allowing further infections to develop.
The cause is not always clear, but can be linked to the following –
- Past recurrent infections
- Immune deficiencies
- Inflammatory conditions such as inflammatory bowel disease and arthritis
Did you know..?
- Subtypes are now described – such as eosinophilic bronchiectasis
- Eosinophilic inflammation is associated with increased exacerbation in bronchiectasis
- Treatments are different for infection (microbiome) vs inflammation
- Bronchiectasis is commonly associated with chronic rhinosinusitis (which is an eosinophilic disorder)
- Approximately 20% of patients with bronchiectasis have eosinophilic inflammation.
Things to consider
- Think about patients’ clinical presentation, background, and treatable traits.
- Check sputum – it’s so important! Not all exacerbations are infection driven.
Reference – (1) AT Hill et al (2022), The British Thoracic (BTS) guidelines for non-cystic fibrosis bronchiectasis
by Rachel Daly – Bronchiectasis Lead, ARNS Respiratory Disease Sub Committee