Respiratory System >
Bronchiectasis

“Abnormal and permanently dilated airways that result in a build-up of excess mucus, increasing risk of infections”

Risk Factors
  • Cystic fibrosis
  • Pulmonary disorders (e.g. TB, COPD, IPF)
  • Exposure to toxic fumes or chemicals
  • Childhood respiratory infections
  • Allergic bronchopulmonary aspergillosis
  • Immune deficiency
Aetiology
  • Cystic fibrosis
  • Mechanical bronchial obstruction (e.g. tumour, mucus, foreign body)
  • Post-infective bronchial damage
  • Granuloma (TB/ sarcoidosis)
  • Immune deficiency
  • Impaired mucociliary clearance
Pathophysiology
  • Cycle of initial infection → inflammation (cytokines and neutrophil elastases) → impaired mucociliary clearance → hypersecretion of mucus (mucus plug) → airway obstruction → microbial colonisation → bronchial dilatation and airway destruction → further inflammation
Clinical Presentation
  • Persistent cough
  • Copious production of purulent sputum
  • Breathlessness (later stages of disease)
  • Haemoptysis
  • Infection
    • An increased volume of sputum and purulence
    • Fever
    • Systemic upset
  • Pleuritic chest pain
  • O/E
    • Can be normal
    • Coarse crackles heard on auscultation
    • Clubbing (especially when due to CF)
Investigations
  • HRCT scanning
    • Non-tapering ‘tram track’ airways
    • Signet ring sign (increased broncho-arterial ratio)
  • Chest X ray
    • Often normal
    • ‘Tram track’ airways
    • Ring shadows
    • Cysts
  • Sputum sample
  • Immune assessment – immunoglobulins and responses to Hib; tetanus and pneumococcal vaccines
Management
  • Airway clearance
    • Breathing technique
    • Autogenic (self-)drainage
    • Postural drainage
    • Nebulised hypertonic saline
  • Anti-inflammatories
    • Long-term azithromycin (macrolide)
    • Inhaled corticosteroids
  • Treatment of infection (2 weeks)
    • Pseudomonas – 750mg ciprofloxacin BD
    • Haemophilus influenzae – amoxicillin/ co-amoxiclav/ doxycycline
    • IV cephalosporin for multi-resistant species
  • Treatment of complications
    • Breathlessness and reduced exercise capacity – pulmonary rehabilitation
    • Massive haemoptysis – resuscitation and airway protection → bronchial artery embolization
    • Respiratory failure – oxygen and NIV
    • Localised disease – surgery
Complications
  • Breathlessness
  • Reduced exercise capacity
  • Massive haemoptysis
  • Respiratory failure
  • Localised disease

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