Bronchiectasis

Bronchiectasis is the permanent dilation of the bronchi and bronchioles due to chronic infection (causes damage to the elastic and muscular components of its wall). It's causes include:

• Previous severe/chronic chest infections

• Disorders of mucocilliary clearance/mucous plugging - Smoking, CF, Primary ciliary dyskinesia

• Bronchial narrowing and obstruction e.g. COPD, Aspiration, Tumours

• Immunodeficiency

• Allergic - Bronchopulmonary aspergillosis (ABPA)

Common causes of infection in these patients are Haemophilius Influenzae, Pseudomonas aeruginosa, Strep pneumoniae, and Stap aureus.

Patients present with:

• Persistent cough w/large amounts of purulent sputum

• Dyspnoea

• Haemoptysis

O/E - Clubbing, Coarse inspiratory crepitations, Wheeze

Investigations

• Spirometry - shows an obstructive pattern

• CXR - thickened bronchial walls, cystic appearance

• Sputum culture

• CT Chest

• Bronchoscopy

Management

Conservative - Smoking cessation, Chest physiotherapy, Annual flu vaccine

Medical - Abx, Bronchodilators if symptoms of dyspnoea and wheeze, Corticosteroids, Carbocysteine (mucolytic)

Surgical - Excision, Transplant