Bronchiectasis

Introduction
This is a disease that causes local irreversible dilation of the bronchial tree.
It is an obstructive lung disease.
It is almost always a result of bronchial obstruction leading to infection with inflammation (distal
to the obstruction) as a result of Cystic Fibrosis.

 Aeitology
Bronchiectasis is not really a disease in itself, it is more a complication of other conditions. For
example, things that can cause bronchiectasis include:
Cystic fibrosis – the most common cause in developed countries
Bordetella pertussis infections (Whooping Cough) can sometimes cause bronchiectasis later in
life
Ciliary dysfunction syndromes
Congenital abnormalities (usually rare ones)
TB – this is the most common cause worldwide
 

Sign/Symptoms
 Chronic cough
 Production of large amounts of foul smelling sputum, which may also contain flecks of blood
 The cough is usually worse in the mornings, and may be brought on by changes in posture
 Finger clubbing may be present
 Recurrent RTI’s, as the patient is unable to clear the pooled secretions that collect
 Fever and malaise - as a result of recurrent infection.
 Haemoptysis – may just be flecks of the sputum, but in ‘dry bronchiectasis’ it may be the only
symptom.
 weight loss.
 Anorexia.
 low-grade fever, and
 Failure to thrive (children).
May be unilateral or bilateral.
 Coarse crackles (numerous) over areas containing large amounts of sputum
 Possible collapse (no breath sounds)
 Reduced or absent breath sounds at areas distal to places of obstruction

Pathophysiology
 Due to the Etiological Factor
Destruction of the alveolar walls
Fibrosing of the remaining parenchyma
Dilatation of airway surrounding scar tissue
Destruction of the airways (lower lobes are most greatly affected)
Pooling of bronchial secretions
Collections of pus.
Damage to Mucociliary transport system
Broncheoectasis

Investigations
 Sputum sample
 CXR .
 Sweat electrolyte testing –if you suspect CF
 Measure mucociliary clearance

Complications
 Pneumonia
 Abscess
 Empyema
 Pulmonary fibrosis
 Cor-Pulmonale
 Metastatic abscesses e.g. in the brain– due to the continued presence of infection
 Massive haemoptysis

Prognosis
This has greatly improved with antibiotic therapy. Ultimately, many patients die from respiratory failure
due to deterioration of the lung tissue. Cor-Pulmonale is also common.
Management
Management of bronchiectasis is the same as the management of Cystic Fibrosis.
Treatment is not curative. It is aimed at reducing the risk of infections, reducing bronchial
secretions, and preventing complications.
 Postural drainage
 Antibiotics - flucloxacillin 500mg every 6 hours, ciprofloxacin, ceftazidime (which can also
be given IV)
 Steroids – can slow down the rate of progression of the disease
 Bronchodilators – may be of use to patients with airflow limitation
 Surgery -Adequate lung function would be available after the operation