Clinical Aspects

Bronchiectasis is a heterogeneous disease that presents a wide range of clinical manifestations from asymptomatic to massive haemoptysis and respiratory failure. With the widespread availability of chest computed tomography, clinicians encounter bronchiectasis more frequently in various degrees of severity and symptom burden, even in asymptomatic patients [1]. It remains to be established what the significance is of bronchiectatic lesions in asymptomatic patients. Additionally, in milder disease, the diagnosis relies on radiographic bronchial/arterial ratios, which may lead to an overestimation of cylindrical bronchiectasis due to small vascular calibres in certain patient populations [2]. For those patients that have symptomatic bronchiectasis, the most common symptom is cough, occurring in 82–96% of patients [3–6]. In fact, cough may be the only symptom for many years. Other common symptoms include daily sputum production, dyspnoea and chest pain (Table 4.1). The frequency and severity of symptoms are often related to the extent of the bronchiectasis and the coexistence with other respiratory or systemic diseases [5]. Sputum production may be affected by recurrent infections, the use of airway clearance devices, antibiotics and other therapies [7]. Patients often report frequent pulmonary infections, although a single severe respiratory infection may result in bronchiectasis. Haemoptysis occurs in 26–51% of the cases often presenting in mild fashion, but can result in shock or respiratory failure if it is massive [3–6].