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Diagnostic tests for some of the specific conditions associated with bronchiectasis may be appropriate depending on the clinical setting.

MANAGEMENT AND TREATMENT

The basic aims in bronchiectasis management are to keep the airways as free of secretions as possible, the background microbiological load low and the number of infective exacerbations to a minimum. This involves the treatment of any underlying conditions. Occasionally, removing a severely damaged section of the lung may be helpful.

(A) General measures

Although it is generally accepted that keeping the airways as free of secretions as possible is an important part of the management, hard evidence that it makes a difference is difficult to find. Patients ideally should be referred to a physiotherapist experienced in the area, so that an appropriate routine may be developed. This may include regular postural drainage (with or without repercussion), advice about coughing techniques, and the use of aids (such as flutter valves) for sputum mobilization.

For patients with significant airflow obstruction, nebulized bronchodilators may assist with clearing secretions. Some authorities recommend inhaled corticosteroids to decrease airway inflammation during exacerbations, but there is still little evidence to support this. Some patients report they find nebulized saline assists with the mobilization of secretions, but evidence that this is an effective practice is still lacking. Acetylcysteine via nebulizer has also been proposed to assist with the mobilizing of secretions in bronchiectasis, as has dornase alfa, but they have not been shown to be consistently helpful.

Immunization with pnuemococcal vaccine (Pneumovax 23) is recommended for patients with bronchiectasis, as is annual influenza vaccination.

(B) Antibiotic therapy

Patients with bronchiectasis often have chronically purulent sputum, which if cultured grows organisms such as Haemophilus influenzae, Streptococcus pneumoniae, Branhamella catarrhalis, Pseudomonas aeruginosa and Staphylococcus aureus. The presence of P. aeruginosa in the airways of these patients is generally associated with more severe disease. One study has shown that any one strain of organism remains present for a mean of 2.3 months. If a patient is clinically stable, it is not appropriate to treat colonizing organisms as this will promote the emergence of antibiotic resistance.

Using antibiotics during acute exacerbations (increased sputum volume, fever, increased sputum purulence plus

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