Table of Contents
Abnormal dilation of distal airways, associated with chronic cough and excessive sputum production.
Causes
Genetic | CF, Young’s syndrome, Kartagener’s syndrome, yellow nail syndrome, α1-antitrypsin deficiency |
Mechanical | Malignancy, foreign body |
Childhood infection | Pertussis, measles, TB, pneumonia |
Immunological | Allergic bronchopulmonary aspergillosis, hypogammaglobulinaemia, HIV, leukaemia, autoimmune |
Clinical features
Symptoms
- Chronic productive cough
- Haemoptysis
- Recurrent chest infections
Signs of bronchiectasis
- Clubbing
- Inspiratory clicks
- Coarse inspiratory crepitations
- Large airway rhonchi
Signs of cause
- Curved yellow nails and lymphoedema (yellow nail syndrome)
- Dextrocardia (Kartagener’s syndrome)
- Young and thin (CF)
Investigations
- Diagnosis
- Chest X-ray: tramlines and ring shadows
- High-resolution CT chest: ‘signet ring sign’ (bronchi larger than the adjacent vasculature) and bronchial wall thickening – diagnostic test
- Spirometry: variable but often obstructive pattern
- To ascertain cause
- Immunoglobulins and electrophoresis
- Aspergillus precipitins and serum IgE
- CF sweat test/genetic mutation analysis
- HIV
- Rheumatoid factor
- α1-antitrypsin
- Sputum culture (to determine any colonising bacteria and sensitivities)
Management
- Exercise and improved nutrition
- Chest physiotherapy
- Prompt treatment of infections (choose antibiotics based on culture sensitivities)
- Rotating antibiotics may be used for prophylaxis if recurrent infections
- Trial of bronchodilator and nebulised hypertonic saline
- Pneumococcal/influenza vaccines
- Lung resection may be considered in localised disease with a poor response to medical management
Try some questions
What is cor pulmonale?
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Which antibiotics may be considered for an exacerbation of bronchiectasis in a patient with multiple sputum cultures growing pseudomonas?
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What is Kartagener’s syndrome?
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