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Bronchiectasis with chronic Pseudomonas infection — RACP Adult Medicine MCQ

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HardRespiratoryBronchiectasis with chronic Pseudomonas infectionRACP Adult Medicine

A 63-year-old woman with CT-confirmed bronchiectasis has four infective exacerbations in the past year. Sputum cultures repeatedly grow Pseudomonas aeruginosa and she has daily purulent sputum despite airway clearance. FEV1 is 58% predicted. What is the most important prognostic factor?

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Correct answer: D — Frequent exacerbations with chronic Pseudomonas infection

Frequent exacerbations and chronic Pseudomonas infection identify a higher-risk bronchiectasis phenotype with faster decline and more admissions. A normal chest radiograph can miss bronchiectasis severity. Rhinitis, previous amoxicillin exposure and absence of wheeze are less prognostically important than infection and exacerbation burden.

Reference: TSANZ bronchiectasis guidance; Therapeutic Guidelines (eTG) Antibiotic