During one of my clinical sessions today in practice, I came across the condition called bronchiectasis. I thought this would be an interesting disease state to share on my Blog, so here is my take on the condition and how it might be managed in the primary care setting…..
Bronchiectasis is a chronic respiratory disease that involves the widening of the airways of the lungs. This disease is believed to be relatively uncommon in the United Kingdom with an estimated 5 in every 1000 adults listed with the complaint. Bronchiectasis can impact upon anyone at any age, but notable symptoms usually develop in middle age. The unusual airway distention (i.e. loss of elasticity and dilatation) results in excessive mucus accumulation that can in turn lead to increased vulnerability to infection. An individual experiencing bronchiectasis may note a persistent, productive cough that releases sputum and causes related breathlessness. Here, symptom extent between individuals can vary tremendously where one person may only complain of a few issues with another having wide-ranging daily issues. A key concern with this respiratory condition is the potential for the development of recurrent lung infections that need to be managed in an appropriate time frame with stand-by medicine prepared for future exacerbation.
The mainstays of treatment for this condition include:
1. Exercises to help clear the mucus out of the lungs
2. Inhaled medicines to help improve airflow (i.e. agents to manage COPD)
3. Antibiotics plus oral steroids to manage lung infections that present over time
4. Surgery as a last resort
The management of respiratory infections secondary to bronchiectasis is outlined by the National Institute for Health and Care Excellence (NICE) NG117 Guidelines that can be located here. The guidance includes the following key points:
· Obtain a sputum sample from those with an acute exacerbation of bronchiectasis
· Send the sample for culture and susceptibility testing
· If appropriate, offer an antibiotic to people with an acute exacerbation
· Consider severity, previous history plus the chance of future complications
Drug therapy may involve for example:
1. Doxycycline: 200mg on day 1, with 100mg each day thereafter, for ~14 days
2. Prednisolone: 30mg for 5 – 7 days only (GOLD 2017 guidelines)
Rescue packs of the above should be considered / provided for immediate use in the future.
The overarching intention with such a management plan is to impede the destructive cycles that can gradually cause worsening damage to the lungs over time
A key concern and ‘red flag’ related to bronchiectasis is coughing up excessive amounts of blood, which can arise due to large blood vessels in the lungs rupturing. This can be life threatening and may require emergency surgery to manage.
In general, the future for those individuals diagnosed with bronchiectasis is highly variable and often depends on the underlying cause / level of severity. Life with this condition can be challenging, but most have a typical life expectancy.
