Etiology

Tip

Bronchiectasis requires the combination of two important processes taking place in the bronchi:

• either local infection
• or inflammation along with either inadequate clearance of secretions, airway obstruction, or impaired host defenses.

These processes result in the permanent dilation of airways.

• Pulmonary infections (i.e., bacterial, viral, fungal), especially severe or chronic infections
• Disorders of secretion clearance or mucous plugging
  • Cystic fibrosis (CF) (Most common congenital cause of bronchiectasis)
  • Primary ciliary dyskinesia (PCD)
  • Allergic bronchopulmonary aspergillosis (ABPA)
  • Kartagener syndrome
  • Smoking: associated with poor ciliary motility
• Bronchial narrowing or other forms of obstruction
  • COPD
  • Aspiration
  • Tumors
• Immunodeficiency (e.g., common variable immunodeficiency, hypogammaglobulinemia, HIV)

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Pathophysiology

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Clinical features

• Chronic productive cough (lasting months to years) with copious mucopurulent sputum
  • The sputum may be green or yellow in color.
• Auscultation
  • Crackles and rhonchi
  • Wheezing
• Dyspnea
• Hemoptysis
• Exacerbations of bronchiectasis
  • Recurrent bouts of pneumonia and acute bacterial infection of sections of dilated bronchi
  • Frequently due to Pseudomonas aeruginosa
  • Features
    • Increased production of mucous above baseline
    • Low-grade fever

Note

Bronchiectasis should be suspected in patients with a chronic cough that produces large amounts of sputum.

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Diagnostics

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In patients with suspected bronchiectasis, diagnosis is confirmed using imaging studies, preferably a HRCT scan. Additional diagnostic studies are useful to identify the underlying cause and possibly provide specific treatment.

Imaging

High-resolution computed tomography (HRCT) chest: confirmatory test

• Bronchial dilation
  • Cylindrical or tubular (most common) : parallel tram track sign and signet ring sign
  • Varicose
  • Saccular or cystic (most severe form)
  • Bronchial dilation can be identified with a bronchial/arterial ratio > 1
• Thickened bronchial walls, mucus plugging, honeycombing (suggests late-stage bronchiectasis)

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Treatment

General measures

• Smoking cessation
• Bronchopulmonary hygiene and chest physiotherapy: e.g., cupping and clapping, postural drainage, directed cough, hydration
• Administer vaccinations (i.e., seasonal influenza vaccine, pneumococcal vaccine).

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