Definition
Permanent dilation of the walls of the bronchi with associated destructive and inflammatory changes leading to chronic airway infection
Causes of Bronchiectasis
Primary (congenital):
- CF
- Primary cilia dyskinesia
- Congenital hypogammaglobulinaemia
Secondary (acquired)
- Childhood infections (TB, Pneumonia, measels, whooping cough)
- Localised disease (bronchial adenoma, TB, foreign body)
- Allergic bronchopulmonary aspergillosis
- RA
- COPD
- Recurrent aspirations
- ILD and pneumoconiosis
- 50% is IDIOPATHIC
History - Presentation
Present:
- Recurrent haemoptysis
- Productive cough
- Dyspnoea and wheeze
- Chronic Sinusitis
- Recurrent chest infection
- Systemic symptoms - Wt loss, fever, anorexia
- R. Heart failure
Hx of Bronchiectasis
Onset of resp problems Childhood infections Other known conditons - CF, TB etc Admissions to Hospital Past treatment - physio, Abx, Bronchodilators Interference on life
Examination - Bronchiectasis
General - unpleasant sputum
Hands - clubbing
Chest - wheeze, insp crackles, gurgly noises, RHF sx, Pectus carinatum
Associated conditions : RA, IBD, CF, GORD
DD for bronchiectasis
Chronic Bronchitis COPD TB Asthma CF
Ix bronchiectasis
CXR - cystic lesions, streaky infiltration, thickened bronchial walls
Sputum microscopy + culture
Sweat testing for CF
Spirometry FEV1 < 40% = severe
High Res CT - Confirms diagnosis
Bronchoscopy - to isolate bleeding and sample for culture
Bloods: FBC and IgE for aspergillus
Management - Non pharm
BD postural drainage Physio Influenza and pneumococcal vaccine smoking cessation Home 02 for severe disease or <93 % on RA
Management - drugs
Abx - during exacerbations or long term if > 3/year
normally amoxicillin for strep pneumonia or haem influenza
Bronchodilators
Treatment of RHF
further management
Surgical removal of localised disease or in the case of severe haemoptysis
Transplant is occasionally appropriate
