Definition of an exacerbation of bronchiectasis
In bronchiectasis (chronic widening of the bronchi), an exacerbation is a worsening of three or more key symptoms for at least 48 hours, with a clinician deciding treatment must change.
Remember
Diagnose an exacerbation from symptoms: three or more key symptoms are worse for at least 48 hours and a clinician decides treatment must change, not from lung function, a scan, a culture result or a hospital admission.
Bronchiectasis is chronic widening of the bronchi (the airways), and some patients already cough and bring up sputum (what the patient coughs up) every day. An exacerbation is a clear worsening of the patient's usual pattern, a flare-up on top of the permanent baseline.
Three or more of the key symptoms need to be worse than usual for at least 48 hours. The key symptoms are cough, sputum volume or consistency, purulent (pus-like) sputum, breathlessness or reduced exercise tolerance, fatigue or malaise, and haemoptysis (coughing up blood). The sputum change is the most recognisable one: more sputum, and sputum that turns purulent (pus-like), is the commonest sign.
A change in treatment, such as antibiotics, is also part of the consensus definition: the clinician decides that the person needs it.
A fall in spirometry (a measurement of lung volumes) with no symptom change does not make an exacerbation. Neither does a new bacterium in the sputum, because people with bronchiectasis often carry bacteria when they are well. Changes on imaging do not make an exacerbation either, since an exacerbation is judged on symptoms. A raised C-reactive protein (a blood marker of inflammation) was deliberately left out of the criteria, and fever is not part of the definition.
Key facts
- Definition
- a deterioration in three or more key symptoms lasting at least 48 hours, with a clinician deciding that treatment must change.
- Key symptoms
- cough, sputum volume or consistency, purulent (pus-like) sputum, breathlessness or reduced exercise tolerance, fatigue or malaise, and haemoptysis (coughing up blood).
- Typical sign
- more sputum, and sputum that becomes more purulent (pus-like) than usual.
- Treatment change
- a clinician decides that the person needs a change in treatment, such as antibiotics.
- Not required
- fever, a new chest X-ray change or a new bacterium in the sputum.
Exam traps
- A fall in spirometry (a measurement of lung volumes) with no change in symptoms does not make an exacerbation, because the definition rests on a change in symptoms and lung function alone was left out of the criteria.
- A new bacterium in the sputum does not make an exacerbation by itself, because people with bronchiectasis often carry bacteria when they are well.
- Only two worse key symptoms are below the threshold, because the definition asks for three or more.
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