Management of Chronic Bronchial Sepsis Due to Bronchiectasis

Abstract

Although saccular bronchiectasis is becoming rare, cylindrical bronchiectasis is increasingly recognized now that thin section computed tomography (CT) scanning is more commonly performed. Patients present with regular sputum production, which may be chronically infected, and frequently with rhinosinusitis. There is often an associated history of wheezy bronchitis in childhood, resolution of symptoms in teenage years, and relapse as an adult, often following a viral illness. The disease may progress insidiously, and undue tiredness is a common symptom. Pathogenesis of established disease involves bacteria-provoked host-mediated inflammatory lung damage. Investigation should include establishing the diagnosis of bronchiectasis and the microbiology of the infection, elucidating the cause if known (in about 40% of cases with the rest being idiopathic), assessing lung structure (by CT) and function, and measuring disease activity. Management might involve prevention, surgery, treatment of specific conditions such as antibody deficiency, as well as treatment of airflow obstruction and sinusitis. Physiotherapy should be taught and practiced regularly to drain the affected lobes. At one extreme antibiotics should be used to eliminate bacteria during an exacerbation, and at the other extreme may be used continuously when lung damage is severe to suppress bacterial numbers and thus control inflammation. If deterioration in lung function occurs despite optimal medical treatment, then lung transplantation might be considered. Improved mucus clearance or control of inflammation seems to be the most likely way future therapy might be improved.