Bronchiectasis

Notes
  • This is an abnormal and irreversible dilation of the bronchi and bronchioles that is characterized by chronic productive cough,copious and/or purulent sputum,recurrent haemoptysis
  • This condition can be congenital or acquired with the following possible causes: cystic fibrosis (number 1 cause), Kartagener’s syndrome, acquired immunity, chronic lung infection (such as TB, pneumonia, measles, Whooping cough, and nontuberculous mycobacteria), anatomical abnormality (such as Williams–Campbell syndrome and Mounier–Kuhn syndrome), obstruction of single bronchus (by tumour and foreign body), obstructive airways disease (such as Asthma and COPD) , defects of mucociliary clearance (such as  Ciliary dyskinesia) and inhalation of toxic chemicals (e.g. in smoking)
  • Chronic inflammation destroys elastin and cartilage leading to relatively irreversible dilation.
  • Statistics: In USA, the prevalence is estimated at 4.2 per 100,000 people in those aged 18 - 34 yrs, rising to 271.8 per 100,000 in people aged 75 yrs. Data of prevalence of this disease from developing countries is not available.
Symptoms
  • Chronic productive cough
  • Copious and/or purulent sputum,
  • Recurrent haemoptysis
  • Dyspnea
  • Wheezing (sometimes)
Diagnosis
  • CXR (results are not conclusive)
  • High resolution CT scan (can give more specific results)
  • Culture of the sputum
  • Baseline pulmonary function tests (PFTs)
Differential
  • TB
  • Pneumonia
  • Cardiac disease
  • Asthma
  • COPD
Prevention
  • Avoid smoking
  • Prompt treatment of pulmonary infections
  • Vaccination
Management
  • Treatment of underlying causes
  • Surgery (rare)
  • Pulmonary toilet
  • To stop smoking
  • Pneumococcal and annual flu vaccines

##When the condition worsens;

  • Culture and sensitivity ( look out for Pseudomonas and Mycoplasma)
  • Titrate oxygen to upto 90%
  • Beta agonist bronchodilators
  • Expectorants
  • Chest physiotherapy

##Prophylactic / treatment  with;

  • Amoxicillin 
  • Azithromycin 
  • Cefaclor (or other cephalosporins)
  • Co-otrimoxazole 
  • Ciprofloxacin 
  • Moxifloxacin  (other quinolones)

##Antipseudomonal antibiotics such as

  • Ticarcillin + clavulanate
  • Meropenem
  • Imipenem + cilastatin 
  • Piperacillin + tazobactam
  • Tobramycin
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