BRONCHIACTASIS

Bronchiectasis is a chronic condition involving the permanent and abnormal dilation of the bronchi and bronchioles due to repeated or severe infections, inflammation, or obstruction. It leads to impaired clearance of mucus, resulting in recurrent infections and progressive lung damage.

Causes

Infectious Causes:

Severe respiratory infections (e.g., tuberculosis, pneumonia, pertussis).

Recurrent lower respiratory tract infections in childhood.

Non-infectious Causes:

Cystic fibrosis (most common genetic cause in some populations).

Primary ciliary dyskinesia (e.g., Kartagener syndrome).

Immunodeficiency (e.g., hypogammaglobulinemia, HIV).

Allergic bronchopulmonary aspergillosis (ABPA).

Connective tissue diseases (e.g., rheumatoid arthritis, Sjögren's syndrome).

Congenital structural abnormalities of the lungs.

Symptoms

Chronic productive cough (often with thick, purulent sputum).

Recurrent chest infections.

Hemoptysis (coughing up blood).

Breathlessness or wheezing.

Fatigue and weight loss.

Digital clubbing in advanced cases.

Diagnosis

Clinical Evaluation:

History of chronic productive cough and recurrent infections.

Physical exam: crackles, wheezing, or decreased breath sounds.

Investigations:

Chest X-ray: May show thickened bronchial walls or "tram-track" appearance.

High-Resolution CT (HRCT): Gold standard for diagnosis; shows bronchial dilation, lack of tapering, and other characteristic features.

Sputum Culture: To identify pathogens (e.g., Pseudomonas aeruginosa, Haemophilus influenzae).

Pulmonary Function Tests: May show obstructive or mixed patterns.

Sweat Chloride Test: For cystic fibrosis.

Immune Function Testing: To rule out immunodeficiency.

Management

Medical Treatment:

Airway Clearance:

Chest physiotherapy (e.g., postural drainage, percussion).

Devices like oscillatory positive expiratory pressure (OPEP).

Antibiotics:

Acute exacerbations: Tailored based on sputum culture.

Chronic suppressive therapy: For recurrent infections, often involving macrolides (e.g., azithromycin).

Bronchodilators: For associated airway obstruction.

Anti-inflammatory Therapy:

Corticosteroids (in specific conditions like ABPA).

Lifestyle Modifications:

Smoking cessation.

Adequate hydration to help thin mucus.

Vaccinations:

Influenza and pneumococcal vaccines to prevent respiratory infections.

Surgery:

Indicated in localized disease unresponsive to medical therapy or recurrent hemoptysis.

Advanced Therapies:

Lung transplantation in severe cases with end-stage lung disease.

Complications

Recurrent infections leading to progressive lung damage.

Respiratory failure.

Cor pulmonale (right-sided heart failure).

Chronic hypoxemia.