Bronchiectasis: An Obstructive Airway Disease

title with a lungs icon

Bronchiectasis is an obstructive airway disease, which is characterized by abnormal permanent dilatation of one or more bronchi due to the destruction of the bronchial wall.
Chronic inflammatory and fibrotic changes may be found in the lung tissue, surrounding the bronchiectatic cavities.
The commonest site of bronchiectasis is the lower lobe of the left lung and lingula. But sometimes it can involve the upper lobe with the predominant features of a dry cough with intermittent episodes of hemoptysis, which is known as bronchiectasis sicca. It is commonly seen in the patient with a granulomatous infection, especially tuberculosis.

Causes of Bronchiectasis:

Bronchiectasis may result from a congenital defect or maybe acquired secondarily from damage to the airway. So the most common causes are-

A. Congenital or Hereditary:

  1. Primary hypogammaglobinemia
  2. Abnormal ciliary function:  

      • Kartagener's syndrome (i.e bronchiectasis with dextrocardia with sinusitis)
      • Young's syndrome (bronchiectasis with sterility)
      • Primary ciliary dyskinesia
       3. Cystic fibrosis (Autosomal recessive disease)

B. Acquired:

  1. History of childhood lung infections like Pneumonia, Measles, Whooping cough, Pulmonary tuberculosis.
  2. Inhaled foreign body or toxins.
  3. Suppurative pneumonia.
  4. Bronchial adenoma.
  5. Allergic bronchopulmonary aspergillosis (causes proximal bronchiectasis).

In children, measles or a whooping cough are the most common cause. But in adults, pulmonary tuberculosis is the most common cause.

Clinical Presentations of Bronchiectasis:

  • A persistent cough with profuse sputum is the most common presentation. It is more marked in the morning after waking from sleep.
  • Haemoptysis (blood mixed with sputum).
  • Pleuritic chest pain, especially when infection involved the pleura.
  • Bad breath or Halitosis.
  • General or systemic features:
            1. Anorexia 
            2. Weight loss 
            3. Malaise 
            4. Fever

On examination of the patient:

  • Generalized clubbing (drumstick appearance of fingers and toes), especially in patients with cystic fibrosis.
  • On lung auscultation: Bilateral basal crepitation may be found but disappear after coughing.

Why Haemoptysis Develops in Bronchiectasis:

Due to dilatation of the bronchial wall, the mucosa becomes friable, slough out and capillaries tear out, as a results bleeding occurs.

Types of Bronchiectasis: 

  1. Saccular or Cystic (more severe form)
  2. Cylindrical
  3. Fusiform

Investigations:

  • High-resolution CT scan is the investigation of choice because it is 90%  sensitive.
  • Chest X-ray P/A view.
  • Others-

      1. Complete Blood Count
      2. X-ray paranasal sinus
      3. Lung function test
      4. Sputum for Gram staining, C/S, AFB, and malignant cell.
      5. Serum immunoglobulin
      6. Sweat test for chloride content: if cystic fibrosis is suspected.

Complications of Bronchiectasis:

  • Secondary infection likes- Pneumonia, Pleurisy.
  • Lung abscess.
  • Pleural effusion.
  • Pulmonary hypertension.
  • Cor pulmonale.
  • Respiratory failure.
  • Brain abscess.
  • Amyloidosis (when kidney involves).

Treatment of Bronchiectasis:

  1. Postural drainage.
  2. If associated infections present, then antibiotics should be given.
  3. Chest physiotherapy.
  4. If obstructive features are present, then bronchodilator should be given.
  5. Sometimes, oral steroids are used, to prevent the progress of the disease.
  6. In case of severe and recurrent hemoptysis surgical intervention (i.e. Lobectomy) may require.

Prognosis of the disease:

Prognosis is relatively good unless bronchiectasis associated with ciliary dysfunction or cystic fibrosis

Prevention of Bronchiectasis:

Bronchiectasis commonly starts in childhood, following measles, whooping cough or primary tubercular infection. So adequate prophylaxis and treatment of these conditions are essential.
Early detection and treatment of bronchial obstruction can also reduce the chance of bronchiectasis. 

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