One article to grasp the key points of bronchiectasis diagnosis and treatment - high score review

Bronchiectasis is a chronic inflammatory disease of the airway caused by pathological and permanent dilation of the bronchi due to various reasons, resulting in repeated purulent infection, clinical manifestations of long-term chronic cough, sputum cough, repeated bacterial infection, tiredness, decreased body mass and progressive airway damage

The causes of bronchiectasis are diverse

Patients with bronchiectasis are more common in women than men, and many patients have never even smoked

When 3 or more of the following conditions occur, i.

The Bronchiectasis Severity Scale and the FACED Scale (which measures first-second forced expiratory volume, age, chronic infection, extent, and dyspnea) (Table 1) are commonly used to assess the prognosis of patients with bronchiectasis

Table 1 Prognostic scores for patients with bronchiectasis

Note: According to the bronchodilation severity index, 0 to 4 is mild, 5 to 8 is moderate, and 9 or more is severe

Bronchiectasis is distinguished from a variety of primary lung diseases and is distinguished by a wet cough and worsening
.

Patients are often misdiagnosed as chronic bronchitis, chronic sinusitis, or other cough-causing conditions
.

Diagnosis requires chest imaging, particularly CT scan
.

Patients confirmed diagnosis with cough (sputum production for most of the week), a history of acute exacerbations of bronchiectasis, and at least one high-resolution CT finding of the following section thickness of 1 mm or less: ratio of 1.
0 or greater in diameter of the internal/external airway to diameter of the artery, unscreened airways, or radiatively
visible airways around them.

Other manifestations of CT in bronchiectasis include mucus blockage and "tree bud sign" nodules
.

Cystic degeneration and cavities
may be seen in advanced patients.

CT findings do not specifically diagnose specific causes or microbial pathogens, but certain manifestations such as right mid-lobe and tongue lobe involvement suggest non-tuberculous mycobacterial infection; Upper lobe involvement of the lungs may be caused by cystic fibrosis; Central bronchiectasis is usually caused by allergic bronchopulmonary aspergillosis (Figure 1
).

Fig.
1 Imaging features of bronchodilation

Note: Flat chest slice in Figure A on the left shows bronchiectasis, upper cystic changes (arrows) and lower lobe "birail signs" (arrows); The middle and right are CT images of the same patient, including the cystic region of the upper left lobe (center, arrow) and two lower lobe of airway thickening (right, arrow).


Figure B shows cavitation and cystic degeneration (left, arrow) and bronchodilation of the right mid lobe and tongue lobes (right, arrow).


The left side of the C figure shows that the right middle lobe is blocked with mucus (arrow), and the lower left leaf (arrow) shows a "bud sign" nodule (arrow); Columnar bronchodilation (arrow)
is visible on the right.

After the diagnosis is confirmed by CT, a systematic examination should be performed based on the patient's medical history and clinical symptoms to further assess the etiology and severity
.

Basic items include detection of potential causes of bronchiectasis, lung function tests, and culture sampling
.

The published guidelines provide procedures that include both general and targeted laboratory testing (Table 2
).

Table 2 Diagnosis and evaluation of bronchiectasis

Note: CFTR indicates cystic fibrosis transmembrane conduction regulatory protein

In terms of sampling and culture, the following points
need to be paid attention to.

Doctors take a culture of the patient's respiratory secretions during diagnosis and regular monitoring, preferably in the event of
an acute exacerbation.

Patients may also collect and send cultures on their own, and in the absence of spontaneous sputum, they can be induced
by drugs or machinery.

Bronchoscopy is not a routine requirement for collecting respiratory samples
.

Sputum needs to be tested for bacterial infections such as acid-fasting bacteria, and some patients also need fungal cultures and viral testing, and common pathogens are detected as follows
.

Chronic infection with Pseudomonas aeruginosa is a key marker
of disease severity and frequency of exacerbations.

Pseudomonas aeruginosa infection is associated
with mortality, number of hospitalizations, number of exacerbations, decreased quality of life, deterioration of lung function, and imaging performance.

Staphylococcal infection has less
effect on disease severity.

Other pathogens, including Streptococcus maltophilus, may worsen
the disease.

In the United States and other countries, non-tuberculous mycobacteria infection is common in patients with bronchiectasis, and it is speculated that it may be a pathogen for the development of bronchiectasis
.

Nocardia is sometimes isolated from respiratory cultures in bronchiectasis patients, but its clinical significance is unclear
.

Fungal cultures in patients may produce a variety of microorganisms, the most common being Aspergillus and Candida spp
.

In addition, viral infections may promote acute exacerbations of bronchiectasis
.

Symptoms associated with bronchiectasis are complex and heterogeneous and require a holistic and individualized approach to treatment, including disease-related education for patients, while clinicians need to understand the impact of disease on patients' quality of life, and regular monitoring of microbiological data is critical
.

Treatment goals include reducing symptoms and improving quality of life, protecting lung function, and reducing overall morbidity and mortality
.

Patients need to be carefully monitored for clinical symptoms, imaging progress, and functional changes
.

Table 3 lists the points of gradual treatment for patients with bronchiectasis
.

Table 3 Treatment points for bronchiectasis

Bronchiectasis is a heterogeneous disorder in which patients of different ages and sexes present with a chronic cough
.

In the future, more rapid diagnostic methods need to be developed and the assessment and treatment options of patients with bronchiectasis need to be improved
.

References:

1.
Wei Qiu,Zhong Juan,Yang Chaomian.
Research progress on the pathogenesis of bronchodilation[J].
Chinese Medical Guidelines,2022,20(23):66-68+75.

2.
 Anne E.
O’Donnell, M.
D.
Bronchiectasis — A Clinical Review.
N Engl J Med 2022; 387:533-545.

3.
Expert consensus on the diagnosis and treatment of bronchiectasis in adults in China[J].
Chinese Journal of Tuberculosis and Respiratory Diseases,2021,44(04):311-321.