Bronchiectasis

• Bronchiectasis

  Irreversible dilation of the bronchi caused by bronchial wall damage from inflammation and infection
• Patho-physiology

  1. Inflammation damage in the bronchi means the airway is too wide to clear itself properly

  2. This leads to a build-up of mucus

  3. Bacteria colonise in trapped mucus and cause further inflammation and damage to the cilia, elastic and muscular tissue

  4. This damage leads to further dilation of the airway which can be localised or widespread
• Mild bronchiectasis

  • Dilated bronchi are smooth and normal branching is preserved
• Severe bronchiectasis

  • Bronchi are intermittently constricted by fibrosis and distal branches may be closed
• Most severe bronchiectasis

  • Bronchi are severely dilated and branches close early on
• Causes of bronchiectasis

  • Lower respiratory infections
  • Immunodeficiencies
  • Respiratory diseases
  • Idiopathic (unknown cause)
  • Congenital (cystic fibrosis, primary capillary dyskineasia)
  • Immunodeficiency
  • Inflammation (infection - viral, fungal or bacterial)
  • Bronchioles obstruction/retraction (foreign body, pulmonary TB, fibrosis)
  • Other respiratory diseases (COPD)
• Symptoms of bronchiectasis

  • Regular productive cough
  • Haemoptysis (in sputum)
  • Infective exacerbations may report fever and pleuritic chest pain
  • Breathlessness
  • Reduced exercise tolerance/fatigue
  • Weight loss
• Objective findings in bronchiectasis

  • During exacerbation - infection signs (HR, temp), Dyspneic at rest, Hypoxaemia/ heypercarbia
  • Chronic - reduced exercise tolerance, clubbing
  • Crackles
  • Productive cough
  • High RR
• Special tests for bronchiectasis

  • Lung function test - FEV1:FEV over 0.8
  • Bronchoscopy
  • CT scan
  • Chest X-ray
  • ABGs - hypoxaemia
  • Sputum culture (for antibiotics)