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

  • Dx with 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)
  • 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
  • High resolution CT: non-tapering tram-track airways & increased bronchoarterial ratio
  • Spirometry: obstructive pattern
  • Sweat test & CF genetic assessment
  • Serum immunoglobulin
• Complications of bronchiectasis

  • Pneumonia
  • Pleural effusion
  • Pneumothorax
  • Massive hemoptysis
• Poorer prognosis of bronchiectasis

  • If lower FEV1 or if infection with pseudomonas
• Management of bronchiectasis

  • Airway clearance technique & mucolytics: chest physiotherapy, postural drainage
  • Antibiotics for treatment of exacerbations (oral or inhaled for bacterial infection)
  • Long-term azithromycin (immunomodulatory, lower exacerbation frequency)
  • Inhaled corticosteroids (beneficial in some patients)
  • Bronchodilators (effectivity not clear)
  • Surgery: lobectomy in localized disease
  • Resuscitation, airway protection, bronchial artery embolization for massive hemoptysis