New concepts in diagnosis and management of bronchiectasis

Bronchiectasis is defined pathologically as an abnormal and permanent dilation of the bronchi. The etiology of this dilation is bronchial inflammation with resultant destruction of the structural components of the bronchial wall. The etiology of the bronchial inflammation is usually infectious, and most of the diseases associated with bronchiectasis are infectious insults or predispose to recurrent infection. The most common symptoms include cough, daily sputum production, dyspnea, hemoptysis, and recurrent fever and pleurisy. Chest roentgenograms are almost always abnormal but lack specificity for the disease. Computed tomography (CT), especially thin-section CT, provides excellent sensitivity and specificity and has become the diagnostic modality of choice. The extent of evaluation to determine a predisposing disease depends on whether the disease is localized or diffuse and on the presence of associated signs and symptoms. Antibiotics are the mainstays of treatment for bronchiectasis. Antibiotics are used in the setting of acute exacerbations and prophylactically to decrease symptoms. Sputum mobilization, bronchodilators, and antiinflammatory therapy may be beneficial, but further investigation is needed. Surgery is beneficial in the setting of localized disease not controlled with medical therapy.