Pathogenesis
Causes of Bronchiectasis
Congenital
- Cystic fibrosis
- Primary ciliary dyskinesia (e.g. Kartegener's syndrome)
- Hypogammaglobulinaemia
Acquired
- Recurrent pneumonia (e.g. in the setting of immunosuppression) - bacterial, tuberculous, fungal
- Chronic obstructive pulmonary disease (COPD)
- Allergic bronchopulmonary aspergillosis (ABPA)
- Autoimmune diseases - rheumatoid arthritis, Sjogren's syndrome, ulcerative colitis
- Chronic aspiration (e.g. secondary to gastroesophageal reflux)
- Airway foreign body
Manifestations
Complications of Bronchiectasis
- Acute exacerbations
- Pulmonary haemorrhage
- Pneumothorax
- Empyema
- Lung abscess
- Cor pulmonale
Diagnosis
Signs of Bronchiectasis
- Oxygen requirement - reduced SpO2, nasal prongs
- Halitosis
- Cough - moist
- Sputum - purulent / haemoptysis
- Clubbing
- Central cyanosis
- Coarse crepitations
- Wheeze
Signs of Complications
- Evidence of empyema - dull percussion note, reduced breath sounds, reduced vocal resonance
- Evidence of right ventricular failure - raised JVP, ascites, pleural effusions, peripheral oedema
- Evidence of pulmonary hypertension - raised JVP, parasternal heave, loud / palpable P2
Complications of Bronchiectasis
- Acute exacerbations
- Pulmonary haemorrhage
- Pneumothorax
- Empyema
- Lung abscess
- Cor pulmonale
Management
Management Strategy
- Treat the underlying cause
- Sputum clearance - bronchodilators, mucolytics, hypertonic saline, physiotherapy, postural drainage
- Reduce inflammation - using macrolides (azithromycin)
- Manage infection - monitor for colonisation, consider antimicrobial prophylaxis
- Vaccinations - influenza, pneumococcus
- Nutritional support
- Home oxygen
- Lung transplant
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