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Bronchiectasis
Chronic dilatation of one or more bronchi / bronchioles
Predisposition
- poor social conditions
- high prevalence of TB
- where immunizations against respiratory infections are rare
- less availability of antibiotics
Aetiology
- Post-pneumonic
- childhood pneumonia / TB
- whooping cough
- measles
- recurrent pneumonia
- cystic fibrosis
- bronchopulmonary aspergillosis
- aspiration of gastric contents / inhalation of toxic chemicals
- immune deficiency
- hypogammaglobulinaemia
- reduced IgA
- abnormal narrowing of bronchus
- extrinsic - e.g. lymph node compression
- intrinsic - e.g. foreign body / tumour
- primary ciliary dyskinesia (Kartagener's syndrome)
- Idiopathic
- miscellaneous
- alpha1-antitrypsin deficiency
- absence of bronchial cartilage
- pulmonary fibrosis
- inflammatory bowel disease
- rheumatoid
arthritis
Pathology
- bronchial infection lead to chronic inflammation and mucus gland
hyperplasia
- bronchial wall destruction with loss of cartilage leads to dilatation
- partial airways collapse during expiration causes airflow limitation
- variable oedema and scarring fibrosis
- Two radiological types - cylindrical or saccular/cystic
Symptoms
- Persistent cough
- chronic purulent sputum
- haemoptyses
- sinusitis
- nasal polyps
- halitosis
- pleurisy with exacerbations
- clubbing (30%)
Signs
- general airflow obstruction
- hyperinflation
- wheezes
- crackles
Investigations
- Hb
- ESR
- Immunoglobulins
- complement copmonents
- Aspergillus precipitins
- alpha1-antitrypsin levels
- sputum culture (normal upper respiratory commensals)
- Haemophilus influenzae (75%)
- Strep pneumoniae
- Moraxella catarrhalis
- Staph. aureus
- Pseudomonas species
- Aspergillus
- pulmonary function tests
- CXR
- abnormal in 90%
- increased lung markings
- volume loss
- crowded vessels
- bronchial wall thickening / tramline shadows
- ring / cystic lesions
- fibrosis
- old TB
- CT thorax
- Sinus radiography
- mucociliary nasal or lung clearance test
- sweat chloride test
- neutrophil function tests
- chemotaxis
- adherence
- superoxide production
- oesophageal pH monitoring
Treatment
- avoid smoking
- physiotherapy
- postural drainage
- chest percussion 2x / day
- antibiotics
- for exacerbations
- high dose, long period (e.g. amoxil 1g TDS for 14 days)
- nebulised if frequent / recurrent
- bronchodilators / inhaled corticosteroids if reversibility demonstrated
- nasal inhaled steroids
- acid suppressive therapy
- bronchoscopy
- vaccinations
- gammaglobulin / alpha1-antitrypsin replacement
- control of associated diseases e.g. rheumatoid arthritis
- surgery if localised or persistent haemoptyses
- transplantation
Complications
- recurrent exacerbations / infections
- haemoptyses
- empyema
- extrapulmonary spread of infection
- amyloidosis
- seronegative arthropathy
- cutaneous vasculitis
- respiratory failure / cor pulmonale
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