5- bronchiectasis

• Bronchiectasis


  Permanent dilation of bronchi due recurrent infection and inflammation that lead to fibrosis and remodeling of bronchial wall
• Causes of bronchiectasis


  • Cystic fibrosis
  • Tuberculosis
  • Recurrent infections
  • Allergic bronchopulmonary aspergillosis
  • Ciliary dysfunction (primary ciliary dyskinesia, young syndrome)
  • Humoral immunodeficiency
  • Sarcoidosis, rheumatoid arthritis
  • Localized airway obstruction due to tumor/foreign body
  • Bronchiectasis associated with another lung disease (esp. COPD, IPF)
  • Congenital (bronchial wall deficiency)
• Allergic bronchopulmonary aspergillosis diagnosis

  Total IgE, aspergillus specific IgE, aspergillus skin testing
• Primary ciliary dyskinesia diagnosis

  Screen with nasal NO
• Humoral immunodeficiency


  May be pan hypogammaglobinemia or selective (IgA, IgG2), may be primary or due to HIV/malignancy
• Clinical presentation of bronchiectasis

  • Chronic productive cough
  • Purulent copious yellow or green sputum
  • Dyspnea
  • Hemoptysis (streak is common, but could be massive à emergency)
  • Pleuritic chest pain (esp. if associated with infection)
  • Finger clubbing, coarse inspiratory crackles, wheeze
• Investigations for bronchiectasis


  • Sputum culture
  • CXR: cystic shadow, thickened bronchial walls (tramline and ring shadow)
  • High resolution CT: GOLD STANDARD (non-tapering tram-track airways & increased bronchoarterial ratio)
  • Spirometry: show obstructive pattern
  • Sweat test & CF genetic assessment
  • Serum immunoglobulin
• Complications of bronchiectasis


  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Massive hemoptysis
  • Poorer prognosis if lower FEV1 or if infection with pseudomonas
• Airway clearance technique


  Chest physiotherapy, postural drainage
• Mucolytics


  Chest physiotherapy, postural drainage
• Antibiotics for treatment of exacerbations

  Oral or inhaled for bacterial infection
• Antibiotics for treatment of exacerbations

  1. Lasts for 2 weeks

  2. If pseudomonas: high dose ciprofloxacin, dual if resistance common

  3. If H. influenzae: co-amoxiclav
• Long-term azithromycin


  Immunomodulatory, lower exacerbation frequency
• Inhaled corticosteroids


  Beneficial in some patients
• Bronchodilators


  Effectivity not clear
• Surgery


  Lobectomy in localized disease
• If massive hemoptysis


  1. Resuscitation, airway protection, bronchial artery embolization

  2. If not successful: surgery