Bronchiectasis—diagnosis and treatment
BACKGROUND: Radiologically evident bronchiectasis is seen in 30% to 50% of patients with advanced chronic obstructive pulmonary disease (COPD). As COPD is now becoming more common around the world, bronchiectasis is as well.
METHODS: We review pertinent articles published before May 2011 that were retrieved by a selective PubMed search.
RESULTS: The principles of treatment of bronchiectasis in patients who do not have cystic fibrosis ("non-CF bronchiectasis") are derived from the treatment of other diseases: secretolytic and anti-infectious treatment are given as in cystic fibrosis, while anti-obstructive treatment is given as in COPD. The few randomized trials of treatment for non-CF bronchiectasis that have been completed to date do not permit the formulation of any evidence-based recommendations. Many potential treatments are now under evaluation. Hypertonic saline is often used because of its demonstrated benefit in CF, even though no benefit has yet been shown for non-CF bronchiectasis. Phase II trials of inhaled mannitol have yielded promising results, leading to phase III trials that are now underway. There may be a future role for inhaled antibiotics, particularly in patients colonized with Gram-negative pathogens. Inhaled tobramycin and colistin are well established in clinical practice, though not approved for non-CF bronchiectasis; clinical trials of aztreonam, ciprofloxacin, and gentamicin are ongoing. Macrolides seem to bring an additional benefit, though the studies that documented this involved only small numbers of patients. Long-term treatment with inhaled antibiotics and/or macrolides is indicated only if a benefit is seen within three months of the start of treatment (less sputum, no exacerbations).
CONCLUSION: A national registry of patients with bronchiectasis should be established to help us gain better knowledge of its prognostic factors and treatment options.
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Marco Avila
Good article
Posted 1 Aug, 2016 at 15:13moaad seif
May someone send me the article
Posted 24 Nov, 2018 at 9:30Thanks in advance
Guichuan Huang
great
Posted 22 Aug, 2018 at 4:30habib shams
Very good
Posted 20 Oct, 2015 at 11:07