Bronchiectasis

Due to chronic inflammation, this causes permanent dilation of bronchi due to recurrent infections or impaired mucociliary clearance. This trapped mucus further causes the chronic infection cycle and airway damage

Etiologies

• Cystic fibrosis (most common in U.S.)
• Recurrent bacterial or viral infections (e.g. post-TB, pertussis)
• Immunodeficiencies (e.g. hypogammaglobulinemia)
• Allergic bronchopulmonary aspergillosis (ABPA)
• Ciliary dyskinesia (e.g. Kartagener syndrome)
• Airway obstruction (e.g. tumor, foreign body)

Clinical Presentation

• Chronic productive cough (often large volumes, purulent)
• Recurrent infections (often with same organism)
• Hemoptysis
• Dyspnea, wheezing
• Fatigue
• +/- digital clubbing

Diagnosis

• High-resolution CT (HRCT) = gold standard:
  • Shows dilated bronchi, "tram-track" or signet ring sign
• Chest X-ray may show linear atelectasis or thickened bronchial walls
• Sputum culture to guide antibiotics
• Test for underlying causes:
  • Sweat chloride test or CFTR genotyping (cystic fibrosis)
  • Serum Ig levels (immunodeficiency)
  • Aspergillus IgE (ABPA)
  • Ciliary testing (e.g. nasal nitric oxide, biopsy for Kartagener)

Chronic daily cough with purulent sputum, recurrent pneumonia, and tram-track on CT — suspect bronchiectasis.

Treatment

• Airway clearance:
  • Chest physiotherapy, postural drainage, inhaled hypertonic saline
• Antibiotics:
  • Acute exacerbations → empiric antibiotics (target pseudomonas if CF)
    • ↑ Cough, ↑ sputum volume/purulence, ± fever, dyspnea
  • Chronic macrolide therapy (azithromycin) in some cases
• Bronchodilators if coexisting asthma/COPD
• Surgical resection for localized disease not responsive to meds
• Vaccines: influenza, pneumococcus