Bronchiectasis
Definition
Chronic infection of bronchi and bronchioles leading to permanent dilation.
Aetiology
Congenital
Acquired
Pathogenesis
Recurrent heavy damage to lung parenchyma --> sputum production --> damage to sputum drainage system --> infections --> repeat
Clinical Features
Sx
Signs
Investigations
Bedside
Imaging
Others
Management
Complications
Source
OHCM 8th Ed 2010
Dr Gregory Haug 2014
Chronic infection of bronchi and bronchioles leading to permanent dilation.
Aetiology
Congenital
- Cystic Fibrosis (CF)
- Young's syndrome
- Kartagener's syndrome
Acquired
- Aspiration of toxin (reflux, turpentine, kerosene)
- Infections: H. influenzae, S. pneumoniae, S. aureus, Klebsiella, P aeruginosa, Mycobact
- Post infection: measles, pertussis, bronchiolitis, pneumonia, TB
- Others: Bronchial obstruction, ABPA, hypogammaglobulinaemia, RA, UC, radiotherapy
- Idiopathic
Pathogenesis
Recurrent heavy damage to lung parenchyma --> sputum production --> damage to sputum drainage system --> infections --> repeat
Clinical Features
Sx
- Persistent cough
- Abundant purulent sputum
- Intermittent haemoptysis
Signs
- Finger clubbing
- Coarse inspiratory crepitations
- Wheezes
Investigations
Bedside
- Spirometry (variable)
Imaging
- CXR (tram tracks = dilation)
- High res CT (dx)
Others
- Sputum culture, bronchoscopy (located site of haemoptysis, obstruction), CF sweat test
Management
- Physiotherapy
- Exercise
- Positive expiratory pressure (PEP)
- Postural drainage (bd) - ineffective
- Vaccines
- Mucolytics
- Hypertonic saline, mannitol (draw h2o to dilute mucus)
- ABx
- Bronchodilators (for obstructive causes)
- CS (for ABPA)
- Surgery (for localised disease, severe haemoptysis)
Complications
- Pneumonia
- Pleural effusion
- Pneumothorax
- Haemoptysis
- Cerebral abscess
- Amyloidosis
Source
OHCM 8th Ed 2010
Dr Gregory Haug 2014