John Kolbe, MD, PhD, is a respiratory physician at Auckland City Hospital and professor of medicine and head of the Department of Medicine at the University of Auckland, New Zealand.
Once bronchiectasis is noted, who should be referred to specialist care?
There’s no real evidence on which I can base my answer, but I think [these are] patients who have a specific etiology for their bronchiectasis, patients who have severe disease, or patients who have high morbidity. So, this sort of etiologies... I think patients who have hypogammaglobulinemia or primary ciliary dyskinesia should probably be referred because they tend to have progressive disease.
I find allergic bronchopulmonary aspergillosis a difficult condition to treat because you are trying to prevent progressive airway damage whilst trying also to protect the patient from the adverse effects of steroids. I think, if there are any challenges associated with the management of those patients, they should be referred.
Whether or not [to refer] patients with bronchiectasis in association with rheumatologic diseases or inflammatory bowel disease really depends on the circumstances. With respect to severity, those who have very abnormal computed tomography (CT) scans or a marked impairment of pulmonary function, but also those who have demonstrably progressive disease, they should be referred.
Finally, there are the patients who have high morbidity despite your best therapeutic efforts. And those are people who have a lot of chronic cough and sputum production, people who have frequent exacerbations, people who have complications. And then on top of that, I think, the people who should be referred are those who you think might be suitable for resection surgery or—I guess this fits under the severity category—people who you think may be candidates for lung transplantation.