Under-diagnosis of Bronchiectasis Hinders Treatment
Not all patients with chronic airway disease have asthma or chronic obstructive pulmonary disease (COPD). Nonspecific symptoms, such as cough and dyspnea can easily be applied in support of an incorrect or incomplete diagnosis and delay initiation of appropriate therapy.1 A considerable proportion of patients may more accurately have a diagnosis of bronchiectasis, or possibly an overlap combination of bronchiectasis with asthma or COPD. Bronchiectasis is the third-most common chronic inflammatory disease of the airway, after asthma and COPD.2
Clinical symptoms of COPD, asthma and bronchiectasis may overlap significantly as symptoms of cough, sputum and dyspnea can occur in either respiratory disease alone.1 Given the clinical overlap with these respiratory diagnoses, an accurate diagnosis of bronchiectasis and differentiation from asthma and COPD becomes imperative.1 Like asthma and COPD, the pathogenesis of bronchiectasis is thought to be driven by an excessive inflammatory response to different stimuli, mostly bacterial and mycobacterial infection. Therefore, parallels between and overlap of bronchiectasis, asthma, and COPD are not surprising and can easily contribute to frequent diagnostic mistakes or delay in correct diagnosis.1
The prevalence of bronchiectasis in patients with COPD is high, especially in advanced stages. The identification of bronchiectasis in COPD has been defined with greater symptomatic severity, more frequent chronic infection and exacerbations, and poor prognosis.2 Typically, the inflammatory pattern of the airways is similar to COPD.1 The presence of bronchiectasis in COPD patients is associated with more frequent and severe exacerbations, impaired quality of life, and possibly reduced survival.2
A recent study found that the presence of bronchiectasis in asthma patients is more frequent in women, in older patients and in those with more comorbidities. In addition, it is related to a higher frequency of infection by Pseudomonas aeruginosa, an increased mean length of hospital stay, costs and number of readmissions were higher in these patients.3 The prevalence of admissions for exacerbation of bronchial asthma with bronchiectasis is increasing over time. Annual incidences of asthma exacerbation, steroid use due to asthma exacerbation, and emergency room visit due to asthma exacerbation were higher in patients with both asthma and bronchiectasis than asthma alone.3 Bronchiectasis may be a risk factor for asthma exacerbation.
If an asthma patient is uncontrolled, a high-resolution CT scan (HRCT) could be considered for determining concurrent bronchiectasis.4 The diagnosis of bronchiectasis is more objective relative to establishing a diagnosis of asthma and COPD because it is based on CT scan and clinical history of compatible symptoms – history of infections, smoking habits, specific respiratory pathogens such as Pseudomonas aeruginosa or nontuberculous mycobacteria, etc.2,4
The differentiation between asthma, COPD, and bronchiectasis in the early stage of disease is extremely important for the adaptation of appropriate treatment and management options of symptoms. Treatment goals vary for each disease state.3 COPD therapy is directed primarily to the relief of symptoms and the prevention of disease progression. In asthma, the primary goal of treatment is to control the underlying inflammatory process with the consequent control of symptoms. In bronchiectasis, the primary goal of treatment is to prevent disease progression and improve the quality of life and symptoms.
For bronchiectasis preventing disease progression means to facilitate airway clearance, suppress bacterial infection and prevent exacerbations.5 Management of these patients requires a comprehensive multimodal therapeutic approach including airway clearance, reducing chronic infection and inflammation, and treatment of exacerbations.5 Antibiotics, especially in the inhalational form, reduce exacerbations and inflammation by decreasing bacterial density. Together, these various treatments work in concert to improve the overall status of the patient with bronchiectasis.5
Patients should be made aware of the range of available airway clearance techniques including HFCWO vest therapy, like the AffloVest®, huff coughing, bronchodilators, hypertonic saline, positive expiratory pressure and exercise. Patient preference and adherence to treatment should be considered when recommending and discussing airway clearance techniques. The frequency and duration of the airway clearance technique should be tailored to the individual and may alter during periods of exacerbation.5
When choosing an airway clearance therapy, it is important to take into consideration both the patient’s and the physician’s suggestions and preferences. An airway clearance regimen should be effective, efficient, easy to use, able to be undertaken independently or with minimal assistance, and should improve lung function. It should also be flexible, comfortable and adaptable to meet the changing needs of the individual patient.
AffloVest is the first battery-operated, mobile during use, High Frequency Chest Wall Oscillation therapy that allows those with respiratory diseases such as bronchiectasis and COPD to receive state-of-the-art airway clearance therapy on the go.
AffloVest is a proven high frequency chest wall oscillation (HFCWO) therapy designed to provide patients the freedom and mobility to customize and enhance airway clearance therapy, help mobilize lung secretions, and promote treatment adherence.
1. Miguel Angel Martinez-Garcia, MA, et al. Bronchiectasis and Chronic Airway Disease: It Is Not Just About Asthma and COPD. Chest Volume 154, Issue 4, Pages 737–739
2. Martinez-Garcia MA, Miravitlles M. Bronchiectasis in COPD Patients: More Than a Comorbidity? Int Journal Chronic Obstructive Pulmonary Disease. 2017;12:1401–1411.
3. Gema Sánchez-Muñoz, et al. Trend from 2001 to 2015 in the Prevalence of Bronchiectasis Among Patients Hospitalized for Asthma and Effect of Bronchiectasis on the In-Hospital Mortality, Journal of Asthma. 2012; 49(4).
4. Kang HR, Choi GS, Park SJ, et al. The Effects of Bronchiectasis on Asthma Exacerbation Tuberc Respiratory Disease (Seoul). 2014; 77(5):209-214. doi:10.4046/trd.2014.77.5.20
5. McShane PJ, Naureckas ET, Tino G, Strek ME. Non-Cystic Fibrosis Bronchiectasis. Am J Respiratory Critical Care Med. 2013;188(6): 647-656