Bronchiectasis

• Chronic infection of the bronchi an bronchiole leading to permanent dilation of the airways
• Main organisms – H. influenzae, Strep, pneumoniae, Staph aureus, Pseudomonas aeruginosa

Causes;

• Congenital;
  • Primary ciliary dyskinesia
  • Kartagener’s syndrome
• Post-infection;
  • Measles
  • Pertussis
  • Bronchiolitis
  • Pneumonia
  • TB
  • HIV
• Other;
  • Bronchial obstruction
  • Allergic bronchopulmonary aspergillosis (ABPA)
  • Hypogammaglobulinaemia
  • RA
  • UC

Clinical features

• Persistent cough, purulent sputum, intermittent haemoptysis
• Clubbing, coarse inspiratory crackles, wheeze

Complications;

• Pneumonia
• Pleural effusion
• Pneumothorax
• Haemoptysis
• Cerebral abscess
• Amyloidosis

Investigations

• Sputum culture
• CXR – cystic shadows, thickened bronchial walls
• HRCT
• Spirometry – assess reversibility
• Bronchoscopy
• Serum Ig, CF sweat test, Aspergillus precipitans, skin prick test

Management

• Postural drainage
• Antibiotics
• Bronchodilators
• Corticosteroids
• Surgery may be indicated in localized disease or to control haemoptysis