Non-cystic fibrosis bronchiectasis: diagnosis and management in 21st century

Bronchiectasis is permanently dilated airways caused by chronic bronchial inflammation secondary to inappropriate clearance of various micro-organisms and recurrent infections in the airways. At diagnosis, one should search for the underlying disease process, most of the time excluding cystic fibrosis (CF). However, in a substantial number of patients no cause is found. Next, patients need individualised therapy and follow-up by monitoring of their symptoms. Useful tools are the Leicester Cough Questionnaire and the Sputum Colour Chart. Screening patients for bacterial colonisation on a regular basis seems to be equally important, as many patients become colonised by pathogenic micro-organisms. Treatment for non-cystic fibrosis bronchiectasis differs in certain aspects from cystic fibrosis bronchiectasis and often lacks evidence. Overall, bronchiectasis is an underestimated disease, not only in prevalence and incidence, but also in its ability to cause morbidity and mortality. Further research into the underlying pathophysiological mechanisms and trials evaluating new treatments are an absolute necessity.