It has been suggested that the widespread application of vaccination programmes in childhood, particularly against measles and pertussis, should cause a significant reduction in the prevalence of bronchiectasis. However, there are no data to support this association. In a recent systematic review of the long-term consequences of childhood pneumonia, bronchiectasis was uncommon, and asthma and COPD were more common. In addition to universal childhood vaccination, it would be prudent to recommend careful treatment of episodes of childhood pneumonia and immunisation against influenza and pneumococcus in appropriate individuals of any age.
Many patients with bronchiectasis have a significant delay in diagnosis and may be labelled as simply having lower respiratory tract infections or an alternate respiratory diagnosis of COPD or asthma. In these cases it is not clear whether earlier specific diagnosis would improve outcomes, but the diagnosis should be considered in all patients presenting with persistent cough productive of sputum. In CF, there is good evidence that the natural history of bronchiectasis can be positively affected by effective antibiotic therapy and drugs that improve mucociliary clearance (see chapter 14). Such evidence is not available in non-CF bronchiectasis.