DISEASE STAGES OF BRONCHIECTASIS
Bronchiectasis severity is determined according to a combination of factors. There are two tools currently available to assess severity of bronchiectasis. These are the Bronchiectasis Severity Index (BSI) and the FACED.
The bronchiectasis severity index using a mix of clinical, radiological and microbiological features and is a strong predictor of morbidity and mortality for this condition. It also give excellent prediction for hospital admission and exacerbations.
The BSI uses the following criteria and is calculated using this Online Calculation Tool (https://www.bronchiectasisseverity.com/15-2/):
| Criteria for BSI | Classification of severity |
|---|---|
| BMI % FEV1 predicted | 0-4 Mild bronchiectasis 1 yr outcome: 0-3.4% hospitalization rate 4 yr outcome: 0-9.2% hospitalization rate |
| Previous hospital admission Has the patient been hospitalized with a severe exacerbation in the past 2 years? | 5-8 Moderate Bronchiectasis 1 yr outcome: 1.0-7.2% hospitalization rate 4 yr outcome: 9.9-19.4% hospitalization rate |
| Number of exacerbations in the previous year mMRC Breathlessness Score Pseudomonas colonization (chronic colonization is defined by the isolation of Pseudomonas aeruginosa in sputum culture on 2 or more occasions, at least 3 months apart in a 1-year period) Radiological Severity | 9+ Severe Bronchiectasis 1 yr outcome: 16.7-52.6% hospitalization rate 4 yr outcome: 41.2-80.4% hospitalization rate |
The FACED consists of 5 dichotomised variables
| Criteria for FACED | Classification of severity |
|---|---|
| F – FEV1 (≥ 50% = 0 points, < 50% = 2 points) | 0 – 2 points: Mild bronchiectasis |
| A – Age (< 70 yrs = 0 points, ≥ 70 years = 2 points | 3 – 4 points: Moderate Bronchiectasis |
| C – Chronic colonization (no Pseudomonas = 0 points, presence of Pseudomonas = 1 point) | 5 – 7 points: Severe Bronchiectasis |
| E – Extension (1-2 lobes affected = 0 points, > 2 lobes affected = 1 point) | |
| D – Dyspnoea – modified Medical Research Council Scale (mMRC) (0-2 = 0 points, 3-4 = 1 point) |
Knowledge of the severity of bronchiectasis can further guide options for both medical and physiotherapy treatment, including the intensity of these treatments.
Many effective treatments are available (and are currently being developed) to help manage bronchiectasis. But it is a condition associated with progressive decline, although the rate of that decline will vary between individuals. A higher frequency of acute exacerbations (flare-ups) are likely to increase the rate of disease progression.
Quitting smoking is the most important modifiable factor in disease progression. It’s never too late to quit.