Measuring Bronchiectasis Severity Beyond Lung Function Tests

In "Measuring Bronchiectasis Severity Beyond Lung Function Tests," our expert turns to how clinicians can meaningfully gauge exacerbation severity beyond standard lung function testing.

Dr. Swenson describes the burden of bronchiectasis exacerbations as significant and self-reinforcing. Each exacerbation, he explains, tends to beget further exacerbations, driving a more virulent disease course along with higher morbidity and mortality over time. Rather than focusing narrowly on quantifying exacerbation severity, Dr. Swenson argues that patient education matters more clinically. Patients need to recognize an exacerbation, report it promptly to their provider, keep a standing sputum sample order on hand, and have antibiotics ready. He points to the Bronchiectasis Action Plan, developed through the Bronchiectasis and NTM Association, as a practical tool that walks patients through recognizing exacerbation symptoms and taking appropriate, timely action before the episode worsens.

Dr. Swenson also outlines rough markers his clinic uses to gauge exacerbation severity. Hospitalization, by definition, signals a severe exacerbation, he says, as does a new requirement for supplemental oxygen the patient did not previously need. Cardiac manifestations such as pulmonary hypertension or cor pulmonale point to more advanced disease. Routine exacerbations, on the other hand, may resolve with a 10-to-14-day course of oral antibiotics and standard clinic follow-up. Dr. Swenson notes that no validated biomarkers currently exist for exacerbation, so his clinic instead relies on a symptom questionnaire, the CAT score, administered at every visit. Though not fully objective, he explains, tracking a patient's CAT score over time can reveal a "hidden" exacerbation, since symptoms are often insidious and patients may not notice they have drifted from their chronic baseline into an active flare, making structured, repeated assessment an important safeguard against under-recognized clinical decline.

The next episode in this series, "The Economic Burden of Bronchiectasis on Patients and the Health System," examines the mounting financial burden bronchiectasis places on patients and the health system.