Bronchiectasis

• Bronchiectasis


  Irreversible and Abnormal dilatation of one or more bronchi, with chronic airway inflammation
• Bronchiectasis


  • Associated with chronic sputum production, recurrent chest infection, and airflow limitation
• Causes of bronchiectasis


  • Primary infective insult
  • Abnormal immune response
  • Developmental disorder
  • Abnormal cilia
  • Viscid mucous production
  • Bronchial obstruction
• Primary infective insult


  Bronchitis (acute, chronic), pneumonia (adenovirus, measles), tuberculosis
• Abnormal immune response


  Immune deficiency (e.g. HIV), hyper-immune response (e.g. allergic bronchopulmonary aspergillosis), autoimmune disease (e.g. lupus, rheumatoid)
• Abnormal cilia


  Immotile cilia syndrome
• Viscid mucus


  Cystic fibrosis
• Bronchial obstruction


  Cancer, lymphadenopathy
• Pathogenesis of bronchiectasis


  1. Atelectasis

  2. Pressure of secretion

  3. Traction "fibrosis"
• Three patterns of bronchiectasis: cystic, varicose, cylindrical
• Common colonized bacteria in bronchiectasis


  • H. influenzae
  • Strept. pneumoniae
  • Klebsiella
  • Ps. aeruginosa
• Ps. aeruginosa


  Causes rapidly progressive and severe bronchiectasis
• Symptoms of bronchiectasis


  • Persistent and productive cough
  • Voluminous and purulent sputum (bronchorrhea)
  • Recurrent acute lower respiratory tract infection
  • Hemoptysis (sometimes massive)
  • General malaise, weight loss
  • Asthma exacerbations in ABPA
• Clinical signs of bronchiectasis


  • Clubbing
  • Ronchi/wheeze on auscultation
  • Coarse crackles (early and mid-inspiratory + expiratory, changeable with cough)
• Investigations for bronchiectasis


  • CXR
  • HRCT (gold standard)
  • Spirometry (obstructive pattern)
  • Sputum culture and sensitivity
  • Investigation for underlying cause (e.g. TB)
• CXR findings


  Ring shadows, tramline shadows
• HRCT findings


  Tubular bronchiectasis, signet ring shadows
• Treatment of bronchiectasis


  1. Antibiotics

  2. Mucolytics

  3. ICS (only with COPD, asthma)

  4. Bronchodilators (only in significant dyspnea, COPD, asthma)

  5. Surgery (lobectomy, in localized disease)

  6. Chest physiotherapy
• Antibiotic treatment


  Oral, injection, inhaled

  Ps. aeruginosa (first time isolation): eradication antibiotic therapy (e.g. ciprofloxacin 750mg twice a day for 2 weeks followed by colistin for at least 3 months)

  Non-Ps. aeruginosa isolates + ≥3 exacerbations/year: culture-based antibiotic + long term macrolide (e.g. azithromycin)
• Inhaled antibiotics


  Examples: colistin, garamycin