Prognosis

Bronchiectasis is an irreversible condition in adults. In children and adolescents, it may be reversible with early detection and effective treatment, thereby avoiding the later deterioration in lung function.[9] The typical disease course consists of periods of symptom control interrupted by periods of exacerbations. Bronchiectasis frequently coexists with other respiratory disease, making it difficult to determine prognosis for bronchiectasis alone.[128] Factors associated with a faster decline in lung function include more frequent severe exacerbations.[129] Hypoxemia, hypercapnia, dyspnea, and radiographic extent of disease have been shown to correlate with mortality. Conversely, a higher body mass index, regularly scheduled doctor visits, and vaccinations improve survival.[75]

The Bronchiectasis Severity Index, validated in the UK and Europe, may help with understanding prognosis and guiding treatment in adults.[111][112][113]

The following factors have been shown by multivariate analysis to independently predict mortality in patients with moderate to severe bronchiectasis:[130]

  • Pseudomonas aeruginosa infection

  • Male sex

  • Advanced age

  • Higher residual volume/total lung capacity ratio

  • Increased wall thickness on computed tomography imaging

  • Low activity level score as judged by St. George's Respiratory Questionnaire.

Quality of life

According to the St. George Respiratory Questionnaire, dyspnea, reduced forced expiratory volume in the first second of expiration (FEV₁), and daily sputum production have the greatest impact on the quality of life in patients with bronchiectasis.[131]

Patients and parents responding to the European Lung Foundation survey reported that exacerbations were one of the top factors that affected the child’s quality of life.[9]

Pseudomonas species in sputum

Pseudomonas species in the sputum of patients with bronchiectasis indicates more extensive lung disease and more severe impairment of pulmonary function than in patients without Pseudomonas species colonization. Some studies have shown that Pseudomonas species colonization is an independent factor associated with a faster decline in lung function. Evidence is conflicting.[129]

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