Non-antimicrobial airway management of non-cystic fibrosis bronchiectasis

Abstract

Bronchiectasis are often encountered in clinical practice, and are characterized by abnormal airway dilatation and distortion associated with impaired mucociliary clearance and mucous plugging, which are frequently associated with recurrent infections. Numerous etiologies can underlie the development of bronchiectasis, but the most important distinction in research and clinical practice is between bronchiectasis due to cystic fibrosis (CF) and bronchiectasis due to all other reasons (non-CF bronchiectasis). The causes of non-CF bronchiectasis are varied and often unclear. Patients disease severity and phenotypes of non-CF bronchiectasis also varied, which can influence disease trajectory, frequency of exacerbations and mortality. This article reviews the published evidence and suggests interventions to enhance airways clearance in patients with non-CF bronchiectasis, which are key components of an individualized therapeutic program in order to achieve symptomatic relief and prevention of exacerbations and functional decline.

Keywords: Airway mucous plugging; Bronchiectasis; Chest physiotherapy; Cystic fibrosis; Mucociliary clearance; Non-cystic fibrosis bronchiectasis.

Fig. 1

Case of mild bilateral bronchiectasis with right middle lobe predominance and scattered tree-in-bud and micronodular pulmonary infiltrates. Patient had prior successful treatment for M. avium complex (MAC) pulmonary disease and had normal pulmonary function test results (E-FACED score = 1). CPT and non-antimicrobial treatment program included annual immunizations, healthy lifestyle habits, and good hydration. Albuterol inhaler twice daily and use of a flutter valve twice daily were also recommended due to presence of signs of bronchiolectasis on imaging and prior MAC pulmonary infection.

Fig. 2

Case of moderate bilateral bronchiectasis and micronodular pulmonary infiltrates with signs of bronchial wall thickening, mucous plugging, and history of chronic sinusitis but no airway colonization with Pseudomonas (E-FACED score = 5). In addition to optimal control of chronic sinusitis and annual immunizations, the patient was recommended to undergo periodic clinical assessments and encouraged to maintain healthy lifestyle habits and good hydration. CPT and non-antimicrobial treatment program included the use of albuterol inhaler, 3% hypertonic saline nebulizations, and flutter valve twice daily and as needed.

Fig. 3

Case of severe symptomatic bilateral bronchiectasis with right middle lobe and lower lobe predominance; severe mucous plugging and extensive micronodular and pulmonary infiltrates; and ongoing treatment for recurrent Pseudomonas pulmonary infection (E-FACED score = 7). In addition to close clinical monitoring along with appropriate prophylactic antimicrobial therapy, annual immunizations, health lifestyle habits, and good hydration, CPT and non-antimicrobial treatment program included the use of bronchodilators, 7% hypertonic saline nebulizations, and the use of vest therapy 3 to 4 times daily, along with outpatient pulmonary rehabilitation.