Update on the management of patients with non cystic fibrosis bronchiectasis
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5th Pulmonary Clinic, Sotiria Chest Diseases Hospital, Athens, Greece
6th Pulmonary Clinic, Sotiria Chest Diseases Hospital, Athens, Greece
Katerina Dimakou   

152 Mesogion Ave., 11527 Athens, Greece
Pneumon 2015;28(3):251–257
Bronchiectasis not due to cystic fibrosis (non CF bronchiectasis) is an underdiagnosed disease, while recently an increase in the prevalence and hospitalizations for bronchiectasis has been reported, causing a substantial burden on healthcare systems. The goal of the appropriate management of patients with non CF bronchiectasis is to cease the “vicious circle” of bronchiectasis. After an initial thorough aetiological investigation, general measures should be offered that include smoking cessation, vaccination against influenza and pneumonococcal infection and oxygen supplementation if respiratory failure occurs. Antibiotics are the cornerstone of treatment. The appropriate antibiotic regimen guided by sputum culture is of great importance in exacerbations of bronchiectasis, while certain algoriths exist for the eradication of Pseudomonas aeruginosa. Long term macrolides and inhaled antibiotics are recommended for patients chronically colonized with P.aeruginosa and in patients who present ≥3 exacerbations per year or even in case of fewer exacerbations but with significant morbidity, as they have shown positive effects in sputum volume and purulence, they reduce the risk of exacerbations and improve symptoms and quality of life. A subset of patients with a significant bronchodilator response and obstructive lung function pattern may benefit from inhaled β2-agonists and/or inhaled corticosteroids. Airway clearance techniques and pulmonary rehabilitation have been found to improve sputum expectoration, reduce hyperinflation and quality of life. Bronchial arterial embolization is the treatment of choice in cases of severe or reccurent haemoptysis, while surgery for bronchiectasis is extremely rare nowadays. New therapies are currently under consideration, while updated recommendations and guidelines are under preparation.
The authors have indicated no financial conflicts of interest.
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