bronchiectasis
BRONCHIECTASIS
Bronchiectasis is an irreversible pathologic dilatation or ectasia of the bronchi due to repeated airway infection and inflammation.
It enhances susceptibility to bronchial infection and increases inflammatory reaction which causes further lung damage.
Classic symptoms of of bronchiectasis are cough with chronic sputum production along with recurring infective exacerbations and hemoptysis.

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
 Bronchial Obstruction & Recurrent Aspiration
  • 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
Cystic Fibrosis (CF)
  • 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
Young Syndrome
  • Syndrome clinically similar to CF
  • Patients have the triad of bronchiectasis, sinusitis & obstructive azoospermia
Primary Ciliary Disorders
  • 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
Allergic Bronchopulmonary Aspergillosis (ABPA)
  • 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
Immunodeficiency States
  • Congenital or acquired immunodeficiency usually present w/ repeated sinus or pulmonary infections
  • Bronchiectasis in AIDS has occurred w/ & w/o obvious preceding pulmonary infections
Alpha1- Antitrypsin (A1AT) Deficiency & Rheumatic Diseases
  • 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
Traction 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
Mild
  • 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
Moderate
  • 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
Severe
  • 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
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