Makindo Medical Notes Comprehensive Medical Encyclopedia | Education for Healthcare Professionals

Makindo Medical Notes "One small step for man, one large step for Makindo"
Download all this content in the Apps now Android App and Apple iPhone/Pad App

MEDICAL DISCLAIMER: The contents are under continuing development and improvements and despite all efforts may contain errors of omission or fact. This is not to be used for the assessment, diagnosis, or management of patients. It should not be regarded as medical advice by healthcare workers or laypeople. It is for educational purposes only. Please adhere to your local protocols. Use the BNF for drug information. If you are unwell please seek urgent healthcare advice. If you do not accept this then please do not use the website. Makindo Ltd.

Bronchiectasis

About

Anaesthetics and Critical Care

Obstetrics Gynaecology

Oncology

Ophthalmology

Oral Medicine and Dentistry

Statistics and Research

Stroke

Surgery

Toxicology

Trauma and Orthopaedics

Twitter

Urology

Note: Bronchiectasis is a chronic destructive airway disease. Around 50% of cases are idiopathic. 🔬

📖 About

Bronchiectasis is a long-term condition with irreversible airway dilatation.
Key features → chronic productive cough, copious sputum, recurrent infections. 🤧
Despite modern therapies, it still causes high morbidity and worsens quality of life.

🧪 Pathology

Chronic infection + inflammation → destruction of smooth muscle + elastic tissue in bronchi.
Leads to distorted airways and poor mucus clearance → vicious cycle of infection. 🔁
Types:
- Cylindrical: Uniform tube-like dilatation.
- Saccular: Balloon-like outpouchings (most severe).
- Varicose: Irregular, beaded appearance.
Histology may show ulceration, fibrosis, and squamous metaplasia of airway epithelium.

⚡ Causes

Cause	Description	Comments
🦠 Infections	TB, pneumonia, pertussis.	Classic global cause of airway destruction.
🧬 Cystic Fibrosis	CFTR defect → thick mucus, chronic colonisation.	Most common genetic cause in UK/Europe.
🪶 Primary Ciliary Dyskinesia	Impaired cilia → mucus retention.	Kartagener’s (PCD + situs inversus).
🛡️ Immune Deficiency	CVID, HIV, IgG subclass deficiency.	Recurrent chest infections → damage.
🌿 ABPA	Allergic response to Aspergillus.	Often in asthmatics or CF patients.
♻️ Autoimmune	RA, IBD-related lung disease.	Inflammation damages bronchi.
🚫 Obstruction	Tumour, foreign body, TB nodes.	Post-obstructive dilatation.
❓ Idiopathic	No identifiable cause.	~50% of adult cases in UK.

🩺 Clinical Features

Chronic cough + large volumes of sputum (may be foul). 🧴
Recurrent infections → febrile exacerbations.
Sputum types → mucoid, mucopurulent, purulent (track volume).
Dyspnoea (mild exertional → severe rest symptoms).
Haemoptysis – from minor streaks to massive bleeds. 🚨
Finger clubbing in longstanding disease.
Exam: coarse inspiratory crackles, wheeze, or ↓ breath sounds.
Systemic → weight loss, fatigue, failure to thrive in children.

🔎 Investigations

Test	Findings	Notes
🩸 Bloods	↑WCC, ESR/CRP in flares.	Track inflammation.
📷 CXR	Tram-tracks, ring shadows.	Suggestive, not diagnostic.
🖥️ HRCT	Gold standard: airway dilation, “signet ring” sign.	Defines severity.
💨 Spirometry	Obstructive (↓FEV1/FVC), mixed patterns.	Track progression.
🧫 Sputum culture	Pseudomonas, H. influenzae, Staph aureus.	Guides antibiotic therapy.
🌿 Aspergillus precipitins	Positive in ABPA.	Helps confirm allergic component.
🔬 Bronchoscopy	Direct view, sampling, remove foreign body.	Localised disease or malignancy suspicion.
🧬 Genetic testing	CFTR, ciliary defects.	Young/early onset cases.

💊 Management

Option	Description	Comments
🏋️ Airway Clearance	Chest physio, PEP devices, postural drainage.	Core therapy for all patients.
💨 Bronchodilators	SABA/LABA if coexisting asthma/COPD.	Relieves symptoms, improves clearance.
💉 ICS	Not routine – consider in asthma/ABPA overlap.	Reduce airway inflammation.
💊 Long-term antibiotics	Macrolides (azithromycin), inhaled aminoglycosides.	For ≥3 exacerbations/yr or Pseudomonas.
💉 Vaccines	Influenza, pneumococcal.	Prevention of infection crucial.
🔪 Surgery	Resection for severe localised disease or massive haemoptysis.	Rare, but life-saving in select cases.
🏃 Pulmonary rehab	Exercise + education.	Improves fitness, reduces breathlessness.

⚠️ Complications

Recurrent infections → progressive decline.
Respiratory failure in severe disease.
Massive haemoptysis (life-threatening).
Pulmonary hypertension + cor pulmonale. ❤️
Secondary amyloidosis (chronic inflammation).

📉 Prognosis

Depends on underlying cause, infection type, and exacerbation frequency.
Pseudomonas colonisation → poorer outcomes.
Adherence to airway clearance + infection control improves survival.

📚 References

3 Clinical Cases — Bronchiectasis 🫁🔄

Case 1 — Post-infective bronchiectasis 🦠: A 34-year-old woman presents with daily productive cough of purulent sputum and recurrent chest infections since childhood measles pneumonia. Exam: coarse crackles and wheeze at lung bases. HRCT: dilated thick-walled bronchi with “signet ring” appearance. Teaching: Severe childhood infections (measles, TB, pertussis) remain a cause of localised bronchiectasis. Sputum culture guides long-term antibiotic therapy; airway clearance is vital.
Case 2 — Cystic Fibrosis (CF) bronchiectasis 🧬: A 22-year-old man with CF presents with worsening breathlessness, weight loss, and daily green sputum. Exam: digital clubbing, scattered coarse crackles. HRCT: widespread upper-lobe bronchiectasis. Teaching: CF is the leading genetic cause of bronchiectasis. Recurrent colonisation with Pseudomonas accelerates decline. Management includes airway clearance, prophylactic antibiotics, and CF-specific therapies.
Case 3 — Immune deficiency-related bronchiectasis 🛡️: A 45-year-old man with recurrent sinopulmonary infections since childhood presents with chronic cough and haemoptysis. Immunology: low IgG levels (common variable immunodeficiency). HRCT: bilateral cylindrical bronchiectasis. Teaching: Bronchiectasis can result from immune deficiency syndromes. Treatment includes immunoglobulin replacement, infection prophylaxis, and physiotherapy for airway clearance.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

Edit