Bronchiectasis

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1- Definition & Types

2- Causes (Aetiology)

3- Pathophysiology

4- Clinical Features & Examination

5- Investigations

6- Management

7- Complications

8- Core Concepts

Definition & Types

Bronchiectasis is the permanent dilatation of the bronchi due to chronic inflammation and infection, leading to destruction of airway walls.

Types (based on CT morphology):

 

  • Cylindrical – smooth, straight, moderately widened

  • Varicose – irregular with bulges

  • Saccular (cystic) – ballooned ends, most severe form

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Causes (Aetiology)

CategoryExamples
Post-infectiveTB, measles, pertussis, pneumonia
CongenitalCystic fibrosis (CF), primary ciliary dyskinesia
ObstructionForeign body, tumour
AllergicABPA (allergic bronchopulmonary aspergillosis)
ImmunodeficiencyCommon variable immune deficiency

Pathophysiology

  • Trigger: Infection or obstruction

  • Inflammation: Neutrophil-driven airway damage

  • Impaired mucociliary clearance

  • Chronic infection: Bacterial colonisation (esp. Pseudomonas aeruginosa)

  • Structural airway damage: Airway dilation, fibrosis

  • Cycle perpetuates: More mucus → more infection → more damage

© image from Wikimedia Commons

Clinical Features & Examination

Symptoms:

  • Persistent productive cough

  • Purulent sputum

  • Haemoptysis (may be massive)

  • Pleuritic chest pain (during exacerbations)

  • Halitosis (foul breath)

  • Recurrent infections, fatigue, weight loss

 Signs:

  • Coarse crackles (over affected lobes)

  • Clubbing

  • Reduced breath sounds or dullness (if collapse or consolidation)

Investigations

-Imaging:

  • CXR: May show tram lines or ring shadows

  • High-Resolution CT (HRCT): Gold standard — shows dilated, thickened bronchi (Fig. 17.29)

-Microbiology:

  • Sputum culture: Check for Pseudomonas, H. influenzae, S. aureus

  • Mycobacterial culture if TB suspected

-Other tests:

  • Immunoglobulin levels

  • Sweat test/CFTR mutation (esp. in young adults)

  • Ciliary function tests (saccharin test, biopsy)

Management

Airway Clearance:

  • Chest physiotherapy: Active cycle of breathing, postural drainage

  • Devices: Flutter valve, positive expiratory pressure (PEP)

– Antibiotics:

  • Exacerbations: Oral or IV depending on severity

  • Chronic colonisation: Long-term or rotating antibiotics (e.g. azithromycin)

– Haemoptysis:

  • Mild: Treat underlying infection

  • Severe: May need bronchial artery embolisation

– Surgery:

  • For localized disease not responding to medical therapy

  • Contraindicated in diffuse or bilateral disease

Complications

  • Respiratory failure

  • Massive haemoptysis

  • Colonisation with Pseudomonas (worse prognosis)

  • Cor pulmonale (right heart failure due to chronic lung disease)

Core Concepts

  • Clubbing + chronic cough = Always consider bronchiectasis

  • CT is diagnostic — not CXR alone

  • Suspect underlying cause in all new cases: CF, immune deficiency, ABPA

  • Regular sputum cultures guide antibiotics and prevent resistance

  • Pseudomonas = worse prognosis and more aggressive treatment

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