Bronchiectasis

Bronchiectasis

• Abnormal and permanently dilated airways

Aetiology

• Congenital
• Deficiency of bronchial wall elements
• Pulmonary sequestration
• Mechanical bronchial obstruction
• Intrinsic
• Foreign body
• Inspissated mucous
• Post-tuberculous stenosis
• Tumour
• Extrinsic
• Lymph node
• Tumour
• Postinfective bronchial damage
• Bacterial and viral pneumonia, including pertussis, measles and aspiration pneumonia
• Granuloma and fibrosis
• Tuberculosis, sarcoidosis, and fibrosing alveolitis
• Immunological over-response
• Allergic bronchopulmonary aspergillosis
• Post-lung transplant
• Immune deficiency
• Primary
• Panhypogammaglobulinaemia
• Selective immunoglobulin deficiencies (IgA and IgG2)
• Secondary
• HIV and malignancy
• Mucociliary clearance defects
• Genetic
• Primary ciliary dyskinesia (Kartagener's syndrome with dextrocardia and situs inversus)
• Cystic fibrosis
• Acquired
• Young's syndrome - azospermia, sinusitis

Investigations

• Chest X-ray
• High-resolution CT of the lung
• Sputum examination
• Sinus X-rays
• Immunoglobulins
• Sweat electrolytes for cystic fibrosis
• Mucociliary clearance

Management

• Postural drainage
• Antibiotics
• Bronchodilators if airflow limitation
• Steroids
• Heart/lung transplant