Bronchiectasis is an abnormal and permanent dilatation of medium sized airway due to damage of their walls.
This usually arises from repeated bacterial or viral infections which result in inflammation and destruction of the structural components of the bronchial tree.
It may be focal or diffuse.
Bronchiectasis has both congenital or acquired causes.
The most important cause is severe or
repeated respiratory infections.
Other causes include:
- Cystic fibrosis
- Other hereditary disorders e.g.vciliary dyskinesia
- Immunodeficiency disorders
- Autoimmune disorders e.g. rheumatoid disease, ulcerative colitis, Sjogren syndrome
- Mechanical factors e.g. chronically enlarged lymph nodes with pressure effect, lung tumour
- Inhaled toxic substances e.g. silica, cola dust, tobacco smoke.
Symptoms and clinical features of bronchiectasis
- Persistent or recurrent cough
- Purulent fetid sputum
- Pleuritic chest pain
With or without a history of preceding pneumonic illness.
- Digital clubbing
- Crepitations, rhonchi and wheezes
- Cor pulmunale and right ventricular failure in chronically hypoxic patients
- Pulmonary tuberculosis
- Lung abscess
- Chronic bronchitis
- Bullous emphysema
Complications of bronchiectasis
- Massive haemoptysis
- Lung abscess
- Mycotic abscess
- Pulmonary amyloidosis
- Ventilatory failure
- Cor pulmunale and right ventricular failure
- Chest radiograph: cystic spaces with air fluid levels
- Bronchography: saccular, cylindrical or varicose bronchial dilatations
- CT scan (of the chest)
- Bronchoscopy: biopsys of endobronchial lesion
- Sputum microscopy, culture,
- Ziehl Nielson microscopy
- Ventilatory function test: obstructive pattern
Treatment for bronchiectasis
- Eliminate underlying pathology
- Improve mucus clearance
- Control infection
- Reverse airflow obstruction
1. Empirical antibiotics in acute exacerbations
- 500mg-1g orally every 8 hours for 5-7 days
- 40mg/kg orally in 3 divided doses daily
- 960mg orally every 12 hours for 5 – 7 days
- 6 weeks to 5months: 120mg orally every 12 hours for 5 – 7 days
- 6months – 5years: 240mg every 12 hours for 5 – 7 days
- 6-12years: 480mg every 12 hours for 5 – 7 days
Switch to appropriate antibiotics as soon as culture results are available.
- 2 puffs (50 μg) twice daily. Can be doubled in severe airway obstruction
- same as adult dose (for children > 4years)
- 1-2 puffs (100 200 μg) 3-4 times daily
- usually 100 μg (1puff) may be
increased to 200 μg with more severe symptoms.
- Supplemental oxygen
- Postural drainage or suction
- Cessation of cigarette smoking
Notable adverse drug reactions, caution
- Prescribers/ dispensers should consult product literature to confirm the strength of various aerosol preparations.
- Salbutamol: palpitations, tremors,
nervous tension, muscle cramps, sleep disturbances, tachycardia, peripheral vasodilation, hypotension.
Prevention of bronchiectasis
- Avoidance of smoking
- Timely and effective treatment of bacterial infections
- Respiratory care during childhood measles