102. An Emphasis on Bronchiectasis

Non-cystic fibrosis bronchiectasis involves permanent abnormal dilation of airways, often resulting from a "vicious cycle" where chronic inflammation and neutrophilic responses impair the mucociliary escalator. This structural damage stems from diverse etiologies, including childhood pulmonary infections, congenital abnormalities like primary ciliary dyskinesia, immune dysfunction, and mechanical obstruction. Diagnosis relies on high-resolution CT findings, such as the signet ring and tram track signs, alongside a clinical history of chronic productive cough. Management prioritizes airway clearance strategies, such as chest physiotherapy and mucoactives, combined with targeted antibiotic therapy for exacerbations. Evidence from the EMBRACE trial supports long-term macrolide use in patients with recurrent exacerbations to reduce microbial burden, although clinical outcomes like FEV1 may not significantly improve. Clinicians must systematically exclude secondary causes while monitoring for complications like non-tuberculous mycobacteria colonization before initiating prolonged antibiotic regimens.