Bronchiectasis

Irreversible and abnormal dilation of the bronchial tree that is generally caused by cycles of bronchial inflammation in addition to mucus plugging and progressive airway destruction

Aetiology

  • Cystic fibrosis - most common cause in developed countries
  • Bronchial narrowing/obstruction - COPD, aspiration, tumours, ABPA
  • Lung infection (e.g. pneumonia, TB), especially severe/chronic infections
  • Immunodeficiency
  • Many other causes, 50% are idiopathic

Pathophysiology

  • Excessive inflammatory response to infection/obstruction leading to fibrosis
  • Airway dilates as surrounding scar tissue contracts
  • The dilation allows for the stasis of mucus → chronic infection
  • The most common strains of bacteria involved in bronchiectasis are Haemophilus influenzae and Pseudomonas aeruginosa

Clinical presentation

Symptoms

  • Chronic productive cough
  • Fever and malaise
  • Haemoptysis (flecks)

Signs

  • Clubbing
  • Recurrent infections
  • Coarse crackles
  • Reduced/absent breath sounds at areas distal to places of obstruction

Investigations

  • High-resolution CT - thickened and dilated airways, ‘tram-line shadowing’
notion image

Management

  • Treat underlying cause
  • Physiotherapy - airway clearance techniques
  • Antibiotics for acute exacerbations
  • Consider long-term antibiotics in frequent exacerbators