Abstract
Bronchiectasis is a chronic respiratory disease characterised by a syndrome of productive cough and recurrent respiratory infections due to permanent dilatation of the bronchi. Bronchiectasis represents the final common pathway of different disorders, some of which may require specific treatment. Therefore, promptly identifying the aetiology of bronchiectasis is recommended by the European Respiratory Society guidelines. The clinical history and high-resolution computed tomography (HRCT) features can be useful to detect the underlying causes. Despite a strong focus on this aspect of treatment a high proportion of patients remain classified as “idiopathic”. Important underlying conditions that are treatable are frequently not identified for prolonged periods of time.
The European Respiratory Society guidelines for bronchiectasis recommend a minimal bundle of tests for diagnosing the cause of bronchiectasis, consisting of immunoglobulins, testing for allergic bronchopulmonary aspergillosis and full blood count. Other testing is recommended to be conducted based on the clinical history, radiological features and severity of disease. Therefore it is essential to teach clinicians how to recognise the “clinical phenotypes” of bronchiectasis that require specific testing.
This article will present the initial investigation and management of bronchiectasis focussing particularly on the HRCT features and clinical features that allow recognition of specific causes.
Abstract
Bronchiectasis is a heterogeneous disease with diverse clinical presentation. Careful history, review of radiological features and laboratory testing are required to identify the underlying diagnosis. http://ow.ly/RDF730koTxu
Footnotes
Provenance: Commissioned article, peer reviewed.
Conflict of interest: J.D. Chalmers reports grants and personal fees (for COPD) from GlaxoSmithKline, Boehringer Ingelheim and Pfizer, grants (for COPD) from AstraZeneca, grants and personal fees (for research into bronchiectasis) from Bayer Healthcare and Grifols, and personal fees (for consultancy) from Napp, outside the submitted work.
- Received February 23, 2018.
- Accepted June 4, 2018.
- Copyright ©ERS 2018.
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