Abstract
Bronchiectasis is a heterogeneous disease that presents a wide range of clinical manifestations from asymptomatic to massive haemoptysis and respiratory failure. With the widespread availability of chest computed tomography, clinicians encounter bronchiectasis more frequently in various degrees of severity and symptom burden, even in asymptomatic patients [1]. It remains to be established what the significance is of bronchiectatic lesions in asymptomatic patients. Additionally, in milder disease, the diagnosis relies on radiographic bronchial/arterial ratios, which may lead to an overestimation of cylindrical bronchiectasis due to small vascular calibres in certain patient populations [2]. For those patients that have symptomatic bronchiectasis, the most common symptom is cough, occurring in 82–96% of patients [3–6]. In fact, cough may be the only symptom for many years. Other common symptoms include daily sputum production, dyspnoea and chest pain (Table 4.1). The frequency and severity of symptoms are often related to the extent of the bronchiectasis and the coexistence with other respiratory or systemic diseases [5]. Sputum production may be affected by recurrent infections, the use of airway clearance devices, antibiotics and other therapies [7]. Patients often report frequent pulmonary infections, although a single severe respiratory infection may result in bronchiectasis. Haemoptysis occurs in 26–51% of the cases often presenting in mild fashion, but can result in shock or respiratory failure if it is massive [3–6].
This is a preview of subscription content, log in via an institution.
References
Kwak HJ, Moon JY, Choi YW, et al. High prevalence of bronchiectasis in adults: analysis of CT findings in a health screening program. Tohoku J Exp Med. 2010;222:237–42.
Diaz AA, Young TP, Maselli DJ, et al. Bronchoarterial ratio in never-smokers adults: implications for bronchial dilation definition. Respirology. 2017;22:108–13.
King PT, Holdsworth SR, Freezer NJ, et al. Characterisation of the onset and presenting clinical features of adult bronchiectasis. Respir Med. 2006;100:2183–9.
Nicotra MB, Rivera M, Dale AM, et al. Clinical, pathophysiologic, and microbiologic characterization of bronchiectasis in an aging cohort. Chest. 1995;108:955–61.
Habesoglu MA, Ugurlu AO, Eyuboglu FO. Clinical, radiologic, and functional evaluation of 304 patients with bronchiectasis. Ann Thorac Med. 2011;6:131–6.
Dimakou K, Triantafillidou C, Toumbis M, et al. Non CF-bronchiectasis: aetiologic approach, clinical, radiological, microbiological and functional profile in 277 patients. Respir Med. 2016;116:1–7.
Lee AL, Burge AT, Holland AE. Airway clearance techniques for bronchiectasis. Cochrane Database Syst Rev. 2015;11:CD008351.
Guilemany JM, Angrill J, Alobid I, et al. United airways again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis. Allergy. 2009;64:790–7.
Braunstahl GJ. The unified immune system: respiratory tract-nasobronchial interaction mechanisms in allergic airway disease. J Allergy Clin Immunol. 2005;115:142–8.
Goeminne PC, Scheers H, Decraene A, et al. Risk factors for morbidity and death in non-cystic fibrosis bronchiectasis: a retrospective cross-sectional analysis of CT diagnosed bronchiectatic patients. Respir Res. 2012;13:21.
Olveira C, Olveira G, Gaspar I, et al. Depression and anxiety symptoms in bronchiectasis: associations with health-related quality of life. Qual Life Res. 2013;22:597–605.
Giron Moreno RM, Fernandes Vasconcelos G, Cisneros C, et al. Presence of anxiety and depression in patients with bronchiectasis unrelated to cystic fibrosis. Arch Bronconeumol. 2013;49:415–20.
Brill SE, Patel AR, Singh R, et al. Lung function, symptoms and inflammation during exacerbations of non-cystic fibrosis bronchiectasis: a prospective observational cohort study. Respir Res. 2015;16:16.
Kapur N, Masters IB, Chang AB. Exacerbations in noncystic fibrosis bronchiectasis: clinical features and investigations. Respir Med. 2009;103:1681–7.
Edwards EA, Metcalfe R, Milne DG, et al. Retrospective review of children presenting with non cystic fibrosis bronchiectasis: HRCT features and clinical relationships. Pediatr Pulmonol. 2003;36:87–93.
Guan WJ, Gao YH, Xu G, et al. Characterization of lung function impairment in adults with bronchiectasis. PLoS One. 2014;9:e113373.
Hurley MN, Prayle AP, Flume P. Intravenous antibiotics for pulmonary exacerbations in people with cystic fibrosis. Cochrane Database Syst Rev. 2015;7:CD009730.
Lynch DA, Newell J, Hale V, et al. Correlation of CT findings with clinical evaluations in 261 patients with symptomatic bronchiectasis. AJR Am J Roentgenol. 1999;173:53–8.
Guan WJ, Gao YH, Xu G, et al. Inflammatory responses, spirometry, and quality of life in subjects with bronchiectasis exacerbations. Respir Care. 2015;60:1180–9.
Lopes AJ, Camilo GB, de Menezes SL, et al. Impact of different etiologies of bronchiectasis on the pulmonary function tests. Clin Med Res. 2015;13:12–9.
Qi Q, Wang W, Li T, et al. Aetiology and clinical characteristics of patients with bronchiectasis in a Chinese Han population: a prospective study. Respirology. 2015;20:917–24.
King PT, Holdsworth SR, Freezer NJ, et al. Lung diffusing capacity in adult bronchiectasis: a longitudinal study. Respir Care. 2010;55:1686–92.
Guan WJ, Gao YH, Xu G, et al. Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications. J Thorac Dis. 2016;8:14–23.
Lee AL, Button BM, Ellis S, et al. Clinical determinants of the 6-minute walk test in bronchiectasis. Respir Med. 2009;103:780–5.
Guan WJ, Gao YH, Xu G, et al. Six-minute walk test in Chinese adults with clinically stable bronchiectasis: association with clinical indices and determinants. Curr Med Res Opin. 2015;31:843–52.
Kharitonov SA, Wells AU, O'Connor BJ, et al. Elevated levels of exhaled nitric oxide in bronchiectasis. Am J Respir Crit Care Med. 1995;151:1889–93.
Ho LP, Innes JA, Greening AP. Exhaled nitric oxide is not elevated in the inflammatory airways diseases of cystic fibrosis and bronchiectasis. Eur Respir J. 1998;12:1290–4.
Foley SC, Hopkins NO, Fitzgerald MX, et al. Airway nitric oxide output is reduced in bronchiectasis. Respir Med. 2007;101:1549–55.
Cho YJ, Lim HJ, Park JS, et al. Measurement of fractional exhaled nitric oxide in stable bronchiectasis. Tuberc Respir Dis (Seoul). 2013;74:7–14.
Chen FJ, Liao H, Huang XY, et al. Importance of fractional exhaled nitric oxide in diagnosis of bronchiectasis accompanied with bronchial asthma. J Thorac Dis. 2016;8:992–9.
Guan WJ, Yuan JJ, Gao YH, et al. Maximal mid-expiratory flow is a surrogate marker of lung clearance index for assessment of adults with bronchiectasis. Sci Rep. 2016;6:28467.
Guan WJ, Gao YH, Xu G, et al. Impulse oscillometry in adults with bronchiectasis. Ann Am Thorac Soc. 2015;12:657–65.
Guan WJ, Yuan JJ, Gao YH, et al. Impulse Oscillometry and Spirometry small-airway parameters in mild to moderate bronchiectasis. Respir Care. 2016;61:1513–22.
Pasteur MC, Bilton D, Hill AT. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65(Suppl 1):i1–58.
Chalmers JD, Goeminne P, Aliberti S, et al. The bronchiectasis severity index. An international derivation and validation study. Am J Respir Crit Care Med. 2014;189:576–85.
Martínez-García MÁ, de Gracia J, Vendrell Relat M, et al. Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score. Eur Respir J. 2014;43:1357–67.
Courtney JM, Kelly MG, Watt A, et al. Quality of life and inflammation in exacerbations of bronchiectasis. Chron Respir Dis. 2008;5:161–8.
Sugianto TD, Chan HK. Inhaled antibiotics in the treatment of non-cystic fibrosis bronchiectasis: clinical and drug delivery perspectives. Expert Opin Drug Deliv. 2016;13:7–22.
Clinkscale D, Spihlman K, Watts P, et al. A randomized trial of conventional chest physical therapy versus high frequency chest wall compressions in intubated and non-intubated adults. Respir Care. 2012;57:221–8.
Prys-Picard CO, Niven R. Urinary incontinence in patients with bronchiectasis. Eur Respir J. 2006;27:866–7.
Kuzniar TJ, Morgenthaler TI, Afessa B, et al. Chronic cough from the patient’s perspective. Mayo Clin Proc. 2007;82:56–60.
Wilson CB, Jones PW, O’Leary CJ, et al. Effect of sputum bacteriology on the quality of life of patients with bronchiectasis. Eur Respir J. 1997;10:1754–60.
Bahali K, Gedik AH, Bilgic A, et al. The relationship between psychological symptoms, lung function and quality of life in children and adolescents with non-cystic fibrosis bronchiectasis. Gen Hosp Psychiatry. 2014;36:528–32.
Mandal P, Morice AH, Chalmers JD, et al. Symptoms of airway reflux predict exacerbations and quality of life in bronchiectasis. Respir Med. 2013;107:1008–13.
Eshed I, Minski I, Katz R, et al. (2007) Bronchiectasis: correlation of high-resolution CT findings with health-related quality of life. Clin Radiol. 2007;62:152–9.
Martínez-García MA, Perpiñá-Tordera M, Román-Sánchez P, et al. Quality-of-life determinants in patients with clinically stable bronchiectasis. Chest. 2005;128:739–45.
Smith MP, Hill AT. Evaluating success of therapy for bronchiectasis: what end points to use? Clin Chest Med. 2012;33:329–49.
Wilson CB, Jones PW, O’Leary CJ, et al. Validation of the St. George’s respiratory questionnaire in bronchiectasis. Am J Respir Crit Care Med. 1997;156(2 Pt 1):536–41.
Chan SL, Chan-Yeung MM, Ooi GC, et al. Validation of the Hong Kong Chinese version of the St. George respiratory questionnaire in patients with bronchiectasis. Chest. 2002;122:2030–7.
Murray MP, Turnbull K, MacQuarrie S. Validation of the Leicester cough questionnaire in non-cystic fibrosis bronchiectasis. Eur Respir J. 2009;34:125–31.
Spinou A, Fragkos KC, Lee KK, et al. The validity of health-related quality of life questionnaires in bronchiectasis: a systematic review and meta-analysis. Thorax. 2016;71:683–94.
Quittner AL, Marciel KK, Salathe MA, et al. A preliminary quality of life questionnaire-bronchiectasis: a patient-reported outcome measure for bronchiectasis. Chest. 2014;146:437–48.
Quittner AL, Marciel KK, Barker AF Quality of Life-Bronchiectasis. The measure is available publicly at: http://www.psy.miami.edu/qol_b/; 2013.
Olveira C, Olveira G, Espildora F, et al. Validation of a quality of life questionnaire for bronchiectasis: psychometric analyses of the Spanish QOL-B-V3.0. Qual Life Res. 2014;23:1279–92.
Quittner AL, O'Donnell AE, Salathe MA, et al. Quality of life questionnaire-bronchiectasis: final psychometric analyses and determination of minimal important difference scores. Thorax. 2015;70:12–20.
Spinou A, Siegert R, Patel A, et al. The development and validation of the bronchiectasis health questionnaire (BHQ). Eur Respir J. 2016;48:PA2555.
Ogilvie AG. The natural history of bronchiectasis: a clinical, roentgenologic and pathologic study. Arch Intern Med. 1941;68:395–465.
Sánchez-Muñoz G, López de Andrés A, Jiménez-García R, et al. Time trends in hospital admissions for bronchiectasis: analysis of the Spanish national hospital discharge data (2004 to 2013). PLoS One. 2016;11:e0162282.
Goeminne PC, Nawrot TS, Ruttens D, et al. Mortality in non-cystic fibrosis bronchiectasis: a prospective cohort analysis. Respir Med. 2014;108:287–96.
Bellelli G, Chalmers JD, Sotgiu G, et al. Characterization of bronchiectasis in the elderly. Respir Med. 2016;119:13–9.
Aliberti S, Lonni S, Dore S, et al. Clinical phenotypes in adult patients with bronchiectasis. Eur Respir J. 2016;47:1113–22.
Martínez-García MÁ, Vendrell M, Girón R, et al. The multiple faces of non-cystic fibrosis bronchiectasis. A cluster analysis approach. Ann Am Thorac Soc. 2016;13:1468–75.
Martínez-García MA, Soler-Cataluña JJ, Perpiñá-Tordera M, et al. Factors associated with lung function decline in adult patients with stable non-cystic fibrosis bronchiectasis. Chest. 2007;132:1565–72.
King PT, Holdsworth SR, Freezer NJ, et al. Outcome in adult bronchiectasis. COPD. 2005;2:27–34.
Finklea JD, Khan G, Thomas S, et al. Predictors of mortality in hospitalized patients with acute exacerbation of bronchiectasis. Respir Med. 2010;104:816–21.
Goeminne PC, Bijnens E, Nemery B, et al. Impact of traffic related air pollution indicators on non-cystic fibrosis bronchiectasis mortality: a cohort analysis. Respir Res. 2014;15:108.
Chalmers JD, Aliberti S, Polverino E, et al. The EMBARC European bronchiectasis registry: protocol for an international observational study. ERJ Open Res. 2016;2:1.
Lonni S, Chalmers JD, Goeminne PC, et al. Etiology of non-cystic fibrosis bronchiectasis in adults and its correlation to disease severity. Ann Am Thorac Soc. 2015;12:1764–70.
Wong C, Jayaram L, Karalus N, et al. Azithromycin for prevention of exacerbations in non-cystic fibrosis bronchiectasis (EMBRACE): a randomised, double-blind, placebo-controlled trial. Lancet. 2012;380:660–7.
Altenburg J, de Graaff CS, Stienstra Y, et al. Effect of azithromycin maintenance treatment on infectious exacerbations among patients with non-cystic fibrosis bronchiectasis: the BAT randomized controlled trial. JAMA. 2013;309:1251–9.
Lee AL, Hill CJ, McDonald CF, et al. Pulmonary rehabilitation in individuals with non-cystic fibrosis bronchiectasis: a systematic review. Arch Phys Med Rehabil. 2016;98(4):774–782.e1.
Mitchell JD, Yu JA, Bishop A, et al. Thoracoscopic lobectomy and segmentectomy for infectious lung disease. Ann Thorac Surg. 2012;93:1033–40.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Maselli, D.J., Restrepo, M.I. (2018). Clinical Aspects. In: Chalmers, J., Polverino, E., Aliberti, S. (eds) Bronchiectasis. Springer, Cham. https://doi.org/10.1007/978-3-319-61452-6_4
Download citation
DOI: https://doi.org/10.1007/978-3-319-61452-6_4
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-61451-9
Online ISBN: 978-3-319-61452-6
eBook Packages: MedicineMedicine (R0)