Bronchiectasis natural history, complications and prognosis

Bronchiectasis is normally diagnosed after months or years of symptoms. Patients have respiratory complications, infection, and hemoptysis. Death can be caused by cardiac and respiratory failure. Bronchiectasis shows a higher mortality with males, advanced age, poor functional status, severe disease based on radiographic findings, and evidence of hypoxemia and hypercapnia.

• There is often a delay between the onset of symptoms and diagnosis
• The classic symptoms are cough, daily mucopurulent sputum production, and dyspnea
  • These symptoms are usually present for months to years
  • The symptoms are manifestations of the lung being repeatedly damaged due to any number of causes

• Over the years the patient can develop recurrent infections, massive hemoptysis, and pulmonary hypertension

• In about 8-10 years, there is a high mortality rate due to cor pulmonale or respiratory failure

• Recurrent infection
• Increased sputum production
• Dyspnea
• Massive hemoptysis
• Pulmonary hypertension
  • Decreased air is traveling through the bronchus
  • Less oxygen is being distributed everywhere
  • Causes pulmonary constriction which increases the pulmonary pressure

• Cor pulmonale
• Respiratory failure

• Bronchiectasis has been shown to contribute to early mortality^[1]
• Early mortality is associated with
  • Males^[1]
  • Advanced age^[2]
  • Poor functional status^[3]
  • More severe disease based on radiographic findings^[4]
  • Evidence of hypoxemia or hypercapnia^[5]

• Infected with Pseudomonas aeruginosa, severe exacerbations, and systemic inflammation are associated with disease advancement
• Up to 10% of adults die within 5-8 years of diagnosis (majority being respiratory related)^[6]

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