5 Things Respiratory Therapists Should Know About Bronchiectasis

Picture of lungs

1. What is bronchiectasis?

Bronchiectasis is an abnormal dilation and thickening of the bronchial walls of the small airways as a result of chronic infection and inflammation.  Bronchiectasis is caused by whole-body systemic diseases such as:

  • COPD
  • Cystic fibrosis
  • Rheumatoid arthritis
  • Aspergillosis
  • Alpha-1 antitrypsin deficiency 
  • Chron’s disease, or ulcerative colitis

The NBRC categorizes bronchiectasis on the RRT board exams as either cystic fibrosis bronchiectasis, or non-cystic fibrosis bronchiectasis (NCFB). Up to 50% of NCFB cases are idiopathic (they have no known cause).

Picture of airway thickening due to the lung disease bronchiectasis
Picture of airway thickening due to the lung disease bronchiectasisBy National Heart Lung and Blood Institute - National Heart Lung and Blood Institute, Public Domain, https://commons.wikimedia.org/w/index.php?curid=29583169

2. What are the symptoms of bronchiectasis?

  • Chronic productive cough for copious amounts of purulent sputum.
  • Frequent pulmonary infections.
  • Green, foul smelling or fetid sputum which may settle in layers if expectorated into a cup.
  • Pseudomonas aeruginosa and MRSA are commonly found in the patient’s sputum culture.
  • Symptoms may resolve slowly or only partially over time.

3. How is bronchiectasis diagnosed?

Chest radiograph and a good medical history may lead you to suspect the patient has bronchiectasis. However, the gold standard for diagnosis of bronchiectasis is via CT-scan of the chest

  • CT-scan of the chest is the gold standard for diagnosis of NCFB (remember to keep in mind that a CT-scan is a time consuming test that should not be performed on the RRT board exam if the patient is unstable. Also, do not order a CT-scan of the chest if a chest radiograph has not yet been performed).
  • Sputum culture and sensitivity to check for bacteria and microbes commonly associated with bronchiectasis.

4. Is bronchiectasis curable?

Unfortunately, the damage to the lungs associated with bronchiectasis cannot be reversed. As a result, the main focus of treatment is to improve the patients symptoms and reduce the frequency of exacerbations.

831px-Bronchiectasis
By BruceBlaus - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=44755609

5. How is bronchiectasis treated?

The following treatments may be considered to reduce symptoms and exacerbations of patients with bronchiectasis:

  • High Frequency Chest Wall Oscillation (HFCWO) can be performed both in and outside the hospital. This is a better alternative for patients being discharged home alone because, unlike with manual chest physiotherapy, it doesn’t require a caregiver.
  • Oscillatory PEP therapy
  • Chest physiotherapy with postural drainage (in hospital only)
  • Antibiotics: Psuedomonas aeruginosa and MRSA are often found in the thick mucus produced inside the airways of patients with bronchiectasis.
  • Inhaled corticosteroids may help if the patient has underlying COPD
  • Dornase alfa (Pulmonzyme) may be given via nebulizer to patients with Non Cystic Fibrosis Bronchiectasis (NCFB) to help break up the mucus.

References

1. Chalmers JD, Aliberti S, Blasi F: Management of bronchiectasis in adults. Eur Respir J.2015;45(5):1446–62. 10.1183/09031936.00119114

2. Bilton D: Update on non-cystic fibrosis bronchiectasis. Curr Opin Pulm Med. 2008;14(6):595–9. 10.1097/MCP.0b013e328312ed8c

3. Pasteur MC, Bilton D, Hill AT: British Thoracic Society guideline for non-CF bronchiectasis. Thorax.2010;65(7):577. 10.1136/thx.2010.142778

About Damon Wiseley 8 Articles
Lead writer at Respiratory Cram RRT-CPFT B.H.S.c. Nova Southeastern University