[Diagnosis and treatment of bronchiectasis. Spanish Society of Pneumology and Thoracic Surgery].
Bronchiectasis is the end result of several different diseases that share principles of management. The clinical course usually involves chronic bronchial infection and inflammation, which are associated with progression. The cause of bronchiectasis should always be investigated, particularly when it can be treated. We recommend evaluating etiology, symptoms, bronchial colonization and infection, respiratory function, inflammation, structural damage, nutritional status, and quality of life in order to assess severity and to monitor clinical course. Care should be supervised by specialized units, at least in cases of chronic bronchial infection, recurrent exacerbations, or when there is a cause that is likely to respond to treatment. Improving symptoms and halting progression are the goals of management, which is based on treatment of the underlying cause and of acute or chronic infections and on the drainage of secretions. Complications that arise must also be treated. Antibiotic prescription is guided by how well infection is being controlled, and this is indicated by the color of sputum and a reduction in the number of exacerbations. We recommend inhaled antibiotics in cases of chronic bronchial infection that does not respond to oral antibiotics, when these cause side effects, or when the cause is Pseudomonas species or other bacteria resistant to oral antibiotics. Inhaled administration is also advisable to treat initial colonization by Pseudomonas species.
Vendrell
Montserrat
M
Servicio de Neumología, Hospital Josep Trueta, Girona, España. CIBER Enfermedades Respiratorias. mvendrell.girona.ics@gencat.cat
de Gracia
Javier
J
Olveira
Casilda
C
Martinez-Garcia
Miguel Angel
MA
Girón
Rosa
R
Máiz
Luis
L
Cantón
Rafael
R
Coll
Ramon
R
Escribano
Amparo
A
Solé
Amparo
A
D000328:Adult; D000402:Airway Obstruction / Q000150:complications; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001987:Bronchiectasis / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D001991:Bronchitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D019587:Dietary Supplements; D019317:Evidence-Based Medicine; D005100:Expectorants / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D010353:Patient Education as Topic; D026741:Physical Therapy Modalities; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005100:Expectorants