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Definition
- An irreversible dilatation & destruction of the bronchi
- Results in airflow obstruction & impaired clearance of secretions
- Enhances susceptibility to bronchial infection & increases inflammatory reaction which causes further lung damage
Etiology
Primary Infections
- Necrotizing infections that are not treated properly or not treated at all is a common cause of bronchiectasis in developing countries
- Typical offending organisms include Klebsiella sp, Staphylococcus aureus, Mycobacterium tuberculosis, Mycoplasma pneumoniae, non-tuberculous mycobacteria, measles, pertussis, influenza, herpes simplex & certain types of adenovirus
- Mycobacterium avium complex (MAC) has propensity to occur in patients who are immunocompetent
- Focal post-obstructive bronchiectasis may occur in endobronchial tumors, broncholithiasis, bronchial stenosis from infections, encroachment of hilar lymph nodes & foreign body aspiration
- Recurrent aspiration caused by gastroesophageal reflux disease or dysphagia may be the cause of bronchiectasis in 1-11.3% adult patients
- In adults, foreign body aspiration may occur w/ altered mental status & when food is not chewed
- Chicken bone fragments may be the cause of lower respiratory tract obstruction in Chinese people from eating cooked meat on the bone
- Typically rare in non-white races
- Autosomal recessive multisystem disorder affecting the chloride transport system in exocrine tissues
- Bronchiectasis is the major pulmonary finding of this disease
- Bronchiectasis due to CF occurs secondary to mucous plugged proximal airways & chronic respiratory infection
- Syndrome clinically similar to CF
- Patients have the triad of bronchiectasis, sinusitis & obstructive azoospermia
- Rare but can cause poor mucociliary clearance, recurrent respiratory infections & bronchiectasis
- Kartagener’s syndrome which is characterized by situs inversus, bronchiectasis, chronic sinusitis w/ immotile cilia
- Hypersensitivity reaction to inhaled Aspergillus antigen that is characterized by bronchospasm, bronchiectasis, & immunologic evidence of a reaction to Aspergillus sp
- Bronchiectasis is secondary to airway plugs of viscid secretions containing hyphae of Aspergillus sp
- CT scan of chest reveals central airway bronchiectasis
- Congenital or acquired immunodeficiency usually present w/ repeated sinus or pulmonary infections
- Bronchiectasis in AIDS has occurred w/ & w/o obvious preceding pulmonary infections
- Pathogenesis of bronchiectasis in these conditions is unclear & may represent only coincidental findings
- Patients w/ A1AT deficiency make-up <1% of the population w/ bronchiectasis
- Individuals whose etiology is connected to rheumatoid arthritis account for only 2-5% of patients w/ bronchiectasis
- Distortion of the airways secondary to distortion of the lung parenchyma from pulmonary fibrosis
Signs and Symptoms
- Classic symptoms of bronchiectasis are cough w/ chronic sputum production; along w/ recurring infective exacerbations & hemoptysis
- Rattly cough producing sputum after colds only
- Sputum production of <10 mL/day
- Change of position may cause sputum production
- May cause mild hemoptysis
- Well patient
- Constant rattly cough
- Sputum production of 10-150 mL/day
- Sputum production most of the time
- Occasional hemoptysis
- May have foul smelling breath
- Usually well patient
- Production of large volumes of sputum
- Sputum production of >150 mL/day
- Occasional pleural pain & hemoptysis
- Usually unwell patient
- May develop resp failure
Symptoms of Exacerbation
- Recognizing acute exacerbation generally depends upon symptomatic changes rather than any specific lab result
- Identification of acute exacerbation may be difficult since the onset may be gradual w/ sputum volume increasing slowly over mth
- Acute bacterial infections are usually indicated by increased sputum production w/ enhanced viscidity, often w/ lassitude, shortness of breath, & pleuritic chest pain
- Fever & chills are generally absent & chest x-ray rarely shows new infiltrates
