Makindo Medical Notes.com Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes.com
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER:The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd

Bronchiectasis

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

Chronic destructive infective inflammatory disorder of airways. 50% are idiopathic

About

Bronchiectasis is a chronic, debilitating condition
Persistent cough, excessive sputum production and recurrent chest infections.
Pathologically there is abnormal and permanent dilatation of the airways

Pathology

Permanent abnormal destructive dilatation of the bronchi with damage to muscle and elastic layers
Pathologically classified as saccular, tubular and fusiform
There is also Ulceration, fibrosis and squamous metaplasia
May be generalised but can indeed be localized causing abnormal dilatation of the airways
Chronic infection, pus formation perhaps distal to some obstructive lesion such as a tumour , foreign body or enlarged lymph nodes

Causes

Cause	Description	Comments
Infections	Chronic or recurrent respiratory infections, such as TB, pneumonia, or whooping cough.	Infections can cause persistent inflammation, leading to damage and dilation of the airways.
Cystic Fibrosis	A genetic disorder that causes thick, sticky mucus to build up in the lungs, leading to chronic infections and bronchiectasis.	Cystic fibrosis is the most common genetic cause of bronchiectasis.
Primary Ciliary Dyskinesia (PCD)	A genetic disorder affecting the cilia, leading to impaired mucus clearance from the respiratory tract.	Impaired ciliary function leads to recurrent infections and bronchiectasis over time.
Immune Deficiencies	Conditions like common variable immunodeficiency (CVID) or HIV/AIDS that weaken the immune system, making patients more susceptible to infections.	Frequent and severe infections in immune-compromised individuals can lead to bronchiectasis.
Allergic Bronchopulmonary Aspergillosis (ABPA)	An allergic reaction to the fungus Aspergillus that can cause inflammation and damage to the airways.	Common with asthma or cystic fibrosis.
Autoimmune Diseases	Conditions such as rheumatoid arthritis, Sjögren's syndrome, or inflammatory bowel disease (IBD) can cause inflammation in the lungs.	Can damage the airways and lead to bronchiectasis.
Congenital Malformations	Conditions present at birth, such as bronchial atresia or congenital tracheobronchomegaly (Mounier-Kuhn syndrome).	Predispose individuals to infections and subsequent bronchiectasis.
Inhalation of Toxic Substances	Chemicals, smoke, or foreign bodies can cause direct injury to the airways.	Acute or chronic exposure can lead to airway damage and bronchiectasis.
Post-Obstructive Bronchiectasis	Obstruction of the airway by tumour, foreign body, or enlarged lymph nodes can lead to localized bronchiectasis. Worldwide the commonest cause is Tuberculosis	Occurs due to persistent obstruction, leading to impaired clearance and infection.
Idiopathic	No identifiable cause; the condition develops without a known underlying trigger.	Idiopathic bronchiectasis accounts for a significant proportion of cases, particularly in older adults.

Clinical

Cough with large amounts of expectorant sputum or even halitosis
Acute on chronic infective episodes
Sputum is mucoid, mucopurulent or purulent - measure volume over 24 hours
Finger clubbing, wheeze copious sputum and long-term amyloidosis
Patients may have tiredness and malaise
Massive haemoptysis may be seen

Investigations

Test	Description	Notes
Bloods	Raised WCC, ESR, CRP suggests acute infection.	Treat infection
CXR	Consolidation, fibrosis, tram lines and signet ring signs	Treat infection
High-Resolution CT (HRCT) Scan	Provides detailed images of the lungs, allowing visualization of the bronchial walls and the extent of bronchiectasis.	Gold standard for diagnosing bronchiectasis; reveals airway dilation, wall thickening, and mucus plugging.
Spirometry	Measures lung function, specifically the volume of air that can be exhaled in one second (FEV1) and total lung capacity (TLC).	Used to assess the degree of airway obstruction and monitor lung function over time.
Sputum Culture	Analyses sputum samples for bacteria, fungi, and mycobacteria to identify infectious agents. Organism include Haemophilus influenzae, Streptococcus pneumonia, Staphylococcus aureus, Moraxella catarrhalis, Pseudomonas aeruginosa (poorer prognosis)	Helps guide antibiotic therapy, especially in patients with recurrent infections or those not responding to initial treatments.
Aspergillus	Aspergillus precipitins.	Treat if positive
Bronchoscopy	A procedure using a bronchoscope to directly visualize the airways and collect samples for further analysis.	Useful for identifying airway obstructions, obtaining biopsies, or removing foreign bodies.
Blood Tests	Includes complete blood count (CBC), immunoglobulin levels, and specific tests for autoimmune diseases or allergies.	Helps identify underlying causes such as immune deficiencies, autoimmune conditions, or allergic bronchopulmonary aspergillosis (ABPA).
Genetic Testing	Tests for specific genetic mutations associated with conditions like cystic fibrosis or primary ciliary dyskinesia.	Indicated in patients with early onset of bronchiectasis or a family history of genetic disorders.
Alpha-1 Antitrypsin Level	Measures the level of alpha-1 antitrypsin, a protein that protects the lungs from damage.	Low levels are associated with alpha-1 antitrypsin deficiency, a genetic cause of bronchiectasis.
Immunoglobulin Levels	Measures levels of IgG, IgA, and IgM to assess for immunodeficiencies.	Low levels may indicate an immune deficiency, increasing susceptibility to infections that can lead to bronchiectasis.
Sweat Chloride Test	Measures the concentration of chloride in sweat, used to diagnose cystic fibrosis.	Indicated in children and young adults with bronchiectasis, particularly if there is a history of chronic lung disease and pancreatic insufficiency.
Autoimmune Screening	Includes tests for rheumatoid factor (RF), antinuclear antibodies (ANA), and other markers of autoimmune diseases.	Used to identify underlying autoimmune conditions such as rheumatoid arthritis or Sjögren's syndrome, which can cause bronchiectasis.

Management

Management Option	Description	Comments
Airway Clearance Techniques	Includes chest physiotherapy, postural drainage, and the use of devices like oscillating positive expiratory pressure (PEP) devices to help clear mucus from the lungs.	Regular airway clearance is essential to reduce mucus build-up and prevent infections.
Bronchodilators	Inhaled medications such as short-acting beta agonists (SABA) and long-acting beta agonists (LABA) to help open the airways and improve breathing.	Often used in patients with coexisting asthma or COPD to relieve symptoms of airway obstruction.
Antibiotics	Used to treat acute exacerbations caused by bacterial infections. Long-term or rotating antibiotic therapy may be considered in patients with frequent exacerbations.	Choice of antibiotic is guided by sputum culture results; oral, inhaled, or intravenous antibiotics may be used depending on severity.
Inhaled Corticosteroids	May be used in patients with coexisting asthma or COPD to reduce airway inflammation.	Not typically used as a primary treatment for bronchiectasis but may help in specific cases with significant airway inflammation.
Vaccinations	Annual influenza vaccination and pneumococcal vaccination to prevent respiratory infections.	Vaccinations are important preventive measures to reduce the risk of infections that can exacerbate bronchiectasis.
Surgery	Considered in localized bronchiectasis or in cases where there is persistent infection or significant bleeding that does not respond to medical treatment.	Surgical resection of the affected lung area may be performed; however, this is reserved for specific cases.
Management of Underlying Conditions	Treatment of underlying conditions such as cystic fibrosis, primary ciliary dyskinesia, or immunodeficiency disorders.	Addressing the root cause is essential to preventing further lung damage and managing bronchiectasis effectively.
Oxygen Therapy	Used in patients with advanced bronchiectasis and chronic respiratory failure to maintain adequate oxygen levels.	Long-term oxygen therapy may be required in patients with severe hypoxemia.
Pulmonary Rehabilitation	A program of exercise, education, and support designed to help patients improve their physical conditioning and manage their symptoms.	Improves exercise capacity, reduces symptoms, and enhances quality of life in patients with chronic lung diseases.
Nutritional Support	Ensuring adequate nutrition, particularly in patients with significant weight loss or malnutrition.	May involve dietary counselling, supplements, or in severe cases, enteral feeding.

Commonest causes of Infection

Pathogen	Commonest Causes	First-line Antibiotic Choice	Alternative Antibiotic Choices
Haemophilus influenzae	A common cause of respiratory infections in bronchiectasis patients.	Amoxicillin	Doxycycline or Co-amoxiclav if resistant or allergic to penicillin.
Pseudomonas aeruginosa	Associated with more severe disease and frequent exacerbations.	Ciprofloxacin (oral) or Ceftazidime (IV)	Tobramycin (inhaled), Piperacillin-Tazobactam (IV), or Meropenem (IV) for resistant cases.
Staphylococcus aureus	MSSA and MRSA.	Flucloxacillin for MSSA; Vancomycin or Linezolid for MRSA	Doxycycline or Co-trimoxazole for MRSA in certain cases.
Moraxella catarrhalis	Commonly in bronchiectasis.	Amoxicillin or Doxycycline	Co-amoxiclav or Levofloxacin in cases of resistance.
Klebsiella pneumoniae	Less common but significant in severe or hospital-acquired infections.	Co-amoxiclav or Cefuroxime	Meropenem or Ciprofloxacin in severe or resistant cases.
Streptococcus pneumoniae	Leading cause of respiratory infections.	Amoxicillin or Penicillin V	Doxycycline or Levofloxacin if penicillin-resistant.
Mycobacterium avium complex (MAC)	Atypical mycobacteria that can cause chronic infection in bronchiectasis patients.	Clarithromycin or Azithromycin combined with Ethambutol and Rifampicin	Consider adding Amikacin (IV) in refractory cases.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Makindo