Introduction

Bronchiectasis is characterized by chronic dilatation and inflammation of bronchi, which may result from numerous defects in host defences, infectious or toxic insults to the lung or chronic pulmonary inflammation resulting from a variety of conditions. Diagnosis is based on high resolution computed tomography (CT) findings of bronchial dilatation and bronchial wall thickening. Until recently bronchial dilatation has been considered irreversible, but recent data suggest that at least some regression of ‘chronic’ changes is possible [1]. Cystic fibrosis (CF) is the most common underlying cause of bronchiectasis; however, as this is discussed in detail elsewhere, this chapter will focus on non-CF bronchiectasis. The true incidence of non-CF bronchiectasis is unknown, but this condition is almost certainly under diagnosed due to a low index of suspicion.

Patients with bronchiectasis commonly present with chronic sputum production; however, episodic haemoptysis in the absence of infection or discrete episodes of respiratory infection with intervening symptom-free periods are seen in a minority of patients. The clinical course is highly variable, with some patients remaining stable for several years and others progressing to respiratory failure. At present little is known about the factors that determine the rate of disease progression in bronchiectasis. Despite extensive investigation, an underlying cause cannot be identified in over 50% of patients [2].However, identification of a cause where possible may have a profound influence on management and aggressive treatment of the underlying cause may prevent or delay the need for transplantation in some patients. In those patients where transplantation is necessary, on-going treatment of the underlying cause of bronchiectasis is likely to delay or prevent recurrence in the allograft.