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Tuesday, February 26, 2013

Bronchiectasis: Causes, Signs and Symptoms, Investigations, Treatment and Complications of Bronchiectasis

Bronchiectasis is abnormal and permanent dilatation of the central and medium-sized airways. This leads to impaired clearance of bronchial secretions with secondary bacterial infection and bronchial inflammation.

Changes in bronchiectasis
Changes in bronchiectasis

Causes of bronchiectasis:

In children:

1. Cystic fibrosis
Changes in airway
2. Congenital ciliary dysfunction syndrome, also known as Kartagener's syndrome or Immotile ciliary syndrome.

In young adults:

1. Pulmonary tuberculosis
2. Inhalation of foreign body

In adults:

1. Pulmonary tuberculosis
2. Ciliary dysfunction syndrome
3. As a complication of Pneumonia, where there is retention of sputum leading to lobar collapse and bronchiectasis.

Clinical Features / Signs and Symptoms:

1. Chronic productive cough early in the morning or with change of posture.
2. Copious amount of foul-smelling green sputum (suggestive of active infection)
3. Halitosis (bad breath)
4. Haemoptysis
5. In dry bronchiectasis: Haemoptysis with little or no sputum production.
6. Breathlessness
7. Wheeze
8. Chest pain

On examination of the patient:

1. Clubbing may be present.
2. Cyanosis
3. On auscultation: Coarse crepitation which is altered with cough.

Investigations done to diagnose Bronchiectasis:

1. Sputum culture: 

Common organisms that cause infection are:

  • Staphylococcus aureus
  • Pseudomonas aeruginosa
  • Haemophilus influenza
  • Aspergillus

2. Chest X ray PA view:

Multiple Cystic lesion: Nodular shadow. Honeycomb appearance mainly in the basal area of lung.
May show dilated bronchi with thickened bronchial walls.

3. Main diagnostic investigation: High resolution CT scan:

Shows airway dilatation, bronchial wall thickening and bronchial wall cysts that are not shown on a standard chest X-ray.

4. Other investigations maybe done according to suspected cause.

For example sweat test in suspected Cystic Fibrosis.

Treatment of bronchiectasis:

1. Respiratory physiotherapy: To help expel the retained sputum. It promotes mucociliary clearance and sputum production.
2. Antibiotics
3. Bronchodilators
4. Inhaled or oral steroids can decrease the rate of progression
5. Surgery is done for the very small minority of with localized disease. Severe disease may require lung or heart-lung transplantation.

Complications of bronchiectasis:

1. Haemoptysis (if massive)
2. Pneumonia
3. Empyema
4. Metastatic cerebral abscess
5. Pneumothorax
6. Respiratory failure

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