Bronchiectasis describes persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi (BTS definition)
It presents as:
- chronic cough with large volumes of sputum
- possibly haemoptysis
Clinically look for finger clubbing.
Causes of bronchiectasis include:
- infective: post severe pneumonia, pertussis, TB
- inflammatory: post gastric aspiration
- congential: CF, Kartageners
- immune-mediated
- immune deficiency - hypogammaglobulinaemia
- immune over-activity - allergic broncho-pulmonary aspergillosis
Conditions associated with bronchiectasis include:
- inflammatory bowel disease
- rheumatoid arthritis
- yellow nail syndrome
Investigations:
- serum immunoglobulins and electrophoresis
- IgE to aspergillus fumigatus and aspergillus precipitins
- CF investigations - sweat chloride and CFTR genetic mutation analysis
- cilary investigation - saccharin test
- bronchoscopy to exclude proximal obstruction
- baseline CXR
- HRCT - look for 'signet ring' = dilated bronchi larger than adjacent vascular bundle
- sputum culture
- lung function tests
Treatment:
- physiotherapy - airway clearance techniques
- bronchodilators if any obstruction
- antibiotics for exacerbations
- first line: amoxicillin, or clarithromycin if penicillin allergic
- ciprofloxacin for those colonised with pseudomonas
- long-term antibiotics if 3 or more exacerbations per year; nebulised antibiotics should be considered
- lung resection may be considered if localised disease and symptoms not controlled with medical management.
Complications
- massive haemoptysis
- cor pulmonale
