Interdisziplinäre Behandlung der Non-Cystic-Fibrosis-Bronchiektasie – State of the Art

Zusamenfassung

Bronchiektasien, die nicht durch eine Zystische Fibrose bedingt sind, sind eine ätiologisch äußerst heterogene Erkrankung. Dieser Beitrag gibt einen Überblick über die Ursachen, das diagnostische Vorgehen und die therapeutischen Optionen bei dieser nicht seltenen Lungenerkrankung.

Abstract

Bronchiectasis is a mostly irreversible bronchial dilatation induced by a destruction of elastic and muscular fibers of the bronchial wall. Radiological criteria of bronchiectasis are met, when the inner diameter of the bronchial wall surpasses the outer diameter of the accompanying pulmonary artery. Its incidence increases with age, even though it often lacks true clinical signs of disease. Only when it is accompanied by cough, expectorations and recurring bronchopulmonary infections, it can be considered a true bronchiectatic disease. Cystic fibrosis (CF) is one of its preeminent triggers, but certainly plays a particular role in this entity, which is why the terminus of “non-CF-bronchiectasis” was coined in the first place.

Multidisciplinary management consists in extensive diagnostic work-up, treatment of potential triggers of bronchiectasis and supportive care in form of vaccination programs, secretolysis and pulmonary rehabilitation, as well as antibiotic treatment of pulmonary exacerbations.

Surgical treatment has to be considered a last resort in case of hemoptysis, recurring severe pneumonia or secondary aspergilloma with complete resection of all pathological findings, ideally by minimally-invasive approach.

Kernaussagen

• Trotz der insgesamt zunehmenden Inzidenz von Bronchiektasen in den westlichen Industrienationen haben die schweren, postinfektiösen Fälle durch gezielte Impfkampagnen und adäquates antibiotisches Management deutlich abgenommen.

• Aufgrund der Vielzahl an möglichen Ursachen, welche zur Entstehung von Bronchiektasen führen, und der Überlappung mit anderen pneumologischen Krankheitsbildern werden Diagnostik und Behandlung zunehmend komplex.

• Dank einer Vielzahl unterschiedlicher und komplementärer konservativer Therapieverfahren ist eine chirurgische Versorgung nur selten notwendig.

• Sollte dies doch der Fall sein, kann diese an entsprechenden Zentren mit hoher Sicherheit oftmals in minimalinvasiver Form erfolgen.

• Ziel ist in diesen Situationen eine vollständige Resektion des betroffenen Areals unter optimalem Erhalt des übrigen Parenchyms.

Schlüsselwörter

Bronchiektasie - Non-CF-Bronchiektasie - Aspergillom - Lungenrehabilitation - Hämoptysen - VATS-Resektion

Key words

bronchiectasis - non-CF-bronchiectasis - aspergilloma - lung rehabilitation - hemoptysis - VATS resection

Publication History

Article published online:
21 June 2021

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