Bronchiectasis: Outcome of treatment

Introduction and Methods: Although bronchiectasis is a common condition for which there are well-recognised treatment modalities, little is known about the natural history of this condition following the initiation of standardised management. To address this issue, between 1978 and 1996, 73 sequential patients with bronchiectasis were commenced on a regimen of chest chysiotherapy and inhaled bronchodilators with antibiotics for exacerbations. On initiation of treatment all patients had 1) a structured clinical interview which assessed symptoms including dyspnoea, volume of sputum haemoptysis, chest pain, sinusitis and general well being, 2) spirometry and 3) radiologie confirmation of bronchiectasis (8 bronchograms 65 chest CT scans). Patients were reviewed in 1998, 6.9±4.7 yrs (mean±SD) after the start of treatment using repeat clinical interview, spirometry and CT. Results:Three patients had died, two from progressive bronchiectasis and another from breast cancer, so that clinical and objective test data was compared in 70 patients aged 59.8 ±13.2 yrs (32 male, 38 female). Clinical Review: With the minimum criteria for change being both a marked alteration in sputum volume and feeling of well being: 30 patients improved, 32 were the same and 8 were worse. Spirometry: With the criteria for change being an alteration in FEV1 of more than 10%: 8 patients improved, 57 were the same and 5 were worse. For the entire group, FEV1 was unchanged before (72.6±23.4) and after treatment (71.4±24.7, p>0.6). Chest CT: Scans reviewed by two independent radiologists were unchanged in 63 patients and worse in 7 patients. Conclusion: The findings were, with this treatment regimen, a marked symptomatic improvement occurred in almost half of patients contrasting with a lack of change in the objective tests of spirometry and chest CT scan.