Bronchiectasis

Dilated airways with frequently

thickened walls

Bronchiectasis: Clinical
Note: Bronchiectasis may happen 2/2 COPD or may be a
separate process with very similar symptoms

Clinical:
Cough (90 %)
Daily sputum production (76%)
Dyspnea (72%)
Hemoptysis (56%)
Recurrent pleurisy

Pathophysiology
2 Prerequisites:
Infectious insult
Impairment of drainage, airway
obstruction, and/or a defect in host
defense.

Pathophys Continued
Infection:
Bacterial, mycobacterial, esp. ABPA central airway
bronchiectasis
Airway obstruction:
intraluminal tumor, foreign body, lymph nodes, COPD
Immunodeficiency:
ciliary dyskinesia, HIV, hypogammaglobulinemia, cystic
fibrosis (obstruction and immunodef.)

Note: this table compares primary bronchiectasis with COPD

Characteristic central bronchiectasis 2/2 ABPA

Note characteristic location in the upper lobes and superior segments

of lower lobes

Exacerbation

Exacerbation: Etiology
+Rx
Colonization/infection:

Hemophilus
Pseudomonas
MAI
Aspergillus

Very difficult to distinguish colonization from acute infection with

these bugs.
Psuedomonas colonized more bronchiectasis on CT; increased
number of hospitalizations vs H. flu colonization
Effect of sputum bacteriology on the quality of life of patients with bronchiectasis . Wilson CB; Jones PW; O'Leary CJ; Hansell DM; Cole PJ;
Wilson R Eur Respir J 1997 Aug;10(8):1754-60.

Treatment:
fluoroquinolone

Prevention
Antibiotics-Controversial:
Consider Macrolide TIW
Cipro qd X 7-14 D/ month
Bronchial Hygiene, physiotherapy,
pulmonary rehab
?bronchodilators, and steroids
Surgery

Citations
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