Table 1 Modalities for monitoring bronchiectasis
    Symptoms and signsIncreased cough, sputum production/volume or purulence, dyspnoea, lethargy, haemoptysis, chest pain70 or deterioration in chest signsPerception issues74 and likely insensitive
Lung function
    SpirometryClassically obstructive, easy to do and use when aged >6 yearsInsensitive and patients can have structural airway changes on HRCT despite normal spirometry75
QOLSGRQ validated for bronchiectasis71 and used in studies29 69 76No bronchiectasis-specific QOL exists
    Chest radiographIncreased markings, lesions, scarring, atelectasis77Poor sensitivity78
    HRCT scanMany scoring systems for bronchiectasis exist,79 80 81 “best” unknown. Exacerbation frequency related to bronchial wall thickening31Impractical for regular use; issues with radiation dose,82 especially in children83
Airway inflammation/oxidation
    Exhaled H2O2Elevated in bronchiectasis, negative correlation with FEV184More studies required Steroids have no effect on H2O2
    Exhaled COElevated in bronchiectasis85More studies required
    Exhaled NODecreased, normal and increased86 values described. Correlation with disease severity if not on steroids86Inconsistent data. Sensitivity unknown, currently unsuitable as a monitoring tool for bronchiectasis.
    Sputum indicesAirway neutrophilia reduces with antibiotic treatment,59 tumour necrosis factor α, interleukin-8, neutrophil elastase also decreases with antibiotics59Useful when asthma or ABPA87 suspected as cause of exacerbation; eg, if eosoinophilia present, systemic corticosteroids likely to be beneficial
    MethacholineIncreased AHR47Direct tests for AHR increasingly recognised to be non specific88
Cardiac assessmentLeft ventricular diastolic dysfunction.89 Correlates with disease severityNo prospective medium/long term cohort available to define role
Exercise testDecreased exercise tolerance,90 lower aerobic capacity and maximal ventilation91No prospective medium/long-term cohort available to define role
  • ABPA, allergic bronchopulmonary aspergillosis; AHR, airway hyper-responsiveness; CO, carbon monoxide; FEV1, forced expiratory volume in 1 s; H2O2, hydrogen peroxide; HRCT, high-resolution computed tomography; NO, nitric oxide; QOL, quality of life; SGRQ, St George’s respiratory questionnaire