Idiopathic Bronchiectasis: A Case-Based Review of Modern Management
While bronchiectasis was first described more than two centuries ago, it is only in the last decade that there have been major advances in our understanding of the condition and in its treatment. Recent evidence has shown that the “vicious cycle hypothesis” of airway inflammation and damage remains valid. The concept of “treatable traits” provides a useful framework on which to base the management of this condition and the co-morbidities that need to be actively managed. In all patients recently diagnosed, a search should be undertaken for specific aetiologies. A number of factors including chronic infection by Pseudomonas aeruginosa, have been shown to be associated with increased morbidity and mortality. While airway clearance strategies remain the mainstay of therapy, other treatments including nebulised hypertonic saline and inhaled antibiotic treatment are of demonstrable benefit. These treatments are discussed in the context of a specific case.