Bronchiectasis

• Bronchiectasis


  Permanent dilation of the bronchi, resulting in chronic cough, continuous sputum production, and recurrent infections
• Potential causes of Bronchiectasis

  • Idiopathic (no apparent cause)
  • Pneumonia
  • Whooping cough (pertussis)
  • Tuberculosis
  • Alpha-1-antitrypsin deficiency
  • Connective tissue disorders (e.g., rheumatoid arthritis)
  • Cystic fibrosis
  • Yellow nail syndrome
• Yellow nail syndrome is characterised by yellow fingernails, bronchiectasis, and lymphoedema. Patients are stable and have good clinical signs, making it a good choice for OSCEs. As it is rare, examiners will score high marks if you can combine these features and name the diagnosis
• Symptoms of Bronchiectasis


  • Shortness of breath
  • Chronic productive cough
  • Recurrent chest infections
  • Weight loss
• Signs of Bronchiectasis on examination

  • Sputum pot by the bedside
  • Oxygen therapy (if needed)
  • Weight loss (cachexia)
  • Finger clubbing
• Symptoms of bronchiectasis


  • Shortness of breath
  • Chronic productive cough
  • Recurrent chest infections
  • Weight loss
• Signs of bronchiectasis on examination

  • Sputum pot by the bedside
  • Oxygen therapy (if needed)
  • Weight loss (cachexia)
  • Finger clubbing
  • Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
  • Scattered crackles throughout the chest that change or clear with coughing
  • Scattered wheezes and squeaks
• Investigations for bronchiectasis


  1. Sputum culture to identify colonising and infective organisms

  2. Chest x-ray findings include tram-track opacities and ring shadows

  3. High-resolution CT (HRCT) is the test of choice for establishing the diagnosis
• Management of bronchiectasis


  1. Vaccines (e.g., pneumococcal and influenza)

  2. Respiratory physiotherapy to help clear sputum

  3. Pulmonary rehabilitation

  4. Long-term antibiotics (e.g., azithromycin) for frequent exacerbations

  5. Inhaled colistin for Pseudomonas aeruginosa colonisation

  6. Long-acting bronchodilators may be considered for breathlessness

  7. Long-term oxygen therapy in patients with reduced oxygen saturation

  8. Surgical lung resection may be considered for specific areas of disease

  9. Lung transplant is an option for end-stage disease

  10. Infective exacerbations require sputum culture before antibiotics and extended courses of antibiotics, usually 7–14 days
• The key features to remember with bronchiectasis are finger clubbing, diagnosis by HRCT, Pseudomonas colonisation and extended courses of 7-14 days of antibiotics for exacerbations