Table of Contents CausesClinical featuresSymptomsSigns of bronchiectasisSigns of causeInvestigations Management Try some questions Abnormal dilation of distal airways, associated with chronic cough and excessive sputum production. Causes GeneticCF, Young’s syndrome, Kartagener’s syndrome, yellow nail syndrome, α1-antitrypsin deficiencyMechanicalMalignancy, foreign bodyChildhood infectionPertussis, measles, TB, pneumoniaImmunological Allergic bronchopulmonary aspergillosis, hypogammaglobulinaemia, HIV, leukaemia, autoimmune Clinical features Symptoms Chronic productive coughHaemoptysisRecurrent chest infections Signs of bronchiectasis ClubbingInspiratory clicksCoarse inspiratory crepitations Large airway rhonchi Signs of cause Curved yellow nails and lymphoedema (yellow nail syndrome)Dextrocardia (Kartagener’s syndrome)Young and thin (CF) Clubbing Investigations DiagnosisChest X-ray: tramlines and ring shadowsHigh-resolution CT chest: ‘signet ring sign’ (bronchi larger than the adjacent vasculature) and bronchial wall thickening – diagnostic testSpirometry: variable but often obstructive patternTo ascertain causeImmunoglobulins and electrophoresisAspergillus precipitins and serum IgE CF sweat test/genetic mutation analysisHIVRheumatoid factorα1-antitrypsinSputum culture (to determine any colonising bacteria and sensitivities) Management Exercise and improved nutritionChest physiotherapyPrompt treatment of infections (choose antibiotics based on culture sensitivities)Rotating antibiotics may be used for prophylaxis if recurrent infectionsTrial of bronchodilator and nebulised hypertonic salinePneumococcal/influenza vaccinesLung resection may be considered in localised disease with a poor response to medical management Try some questions What is cor pulmonale? Oops! This section is restricted to members. Which antibiotics may be considered for an exacerbation of bronchiectasis in a patient with multiple sputum cultures growing pseudomonas? Oops! This section is restricted to members. What is Kartagener’s syndrome? Oops! This section is restricted to members.