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Related Subjects: Asthma |Acute Severe Asthma |Exacerbation of COPD |Pulmonary Embolism |Cardiogenic Pulmonary Oedema |Pneumothorax |Tension Pneumothorax |Respiratory (Chest) infections Pneumonia |Fat embolism |Hyperventilation Syndrome |ARDS |Respiratory Failure |Diabetic Ketoacidosis
Bronchiectasis is a chronic destructive infective inflammatory disorder of airways. Approximately 50% of cases are idiopathic, with no identifiable underlying cause.
Cause | Description | Comments |
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Infections | Chronic or recurrent infections, such as TB, pneumonia, or whooping cough. | Infections cause persistent inflammation, leading to airway damage and dilation. |
Cystic Fibrosis (CF) | Genetic disorder leading to thick, sticky mucus in the lungs, causing chronic infections and bronchiectasis. | Most common genetic cause; 1 in 25 people in the UK carry a CF gene mutation. |
Primary Ciliary Dyskinesia (PCD) | Impaired ciliary function prevents effective mucus clearance from the respiratory tract. | Recurrent infections lead to airway damage over time. |
Immune Deficiencies | Conditions like common variable immunodeficiency (CVID) or HIV/AIDS increase susceptibility to infections. | Frequent and severe infections lead to bronchiectasis. |
Allergic Bronchopulmonary Aspergillosis (ABPA) | Allergic reaction to the fungus Aspergillus causing airway inflammation and damage. | Common in patients with asthma or CF. |
Autoimmune Diseases | Conditions like rheumatoid arthritis or inflammatory bowel disease can cause inflammation in the lungs. | Can lead to airway damage and subsequent bronchiectasis. |
Post-Obstructive Bronchiectasis | Obstruction of the airway by tumours, foreign bodies, or enlarged lymph nodes. | Common cause globally is tuberculosis. |
Idiopathic | No identifiable underlying cause. | Accounts for a significant proportion of cases, particularly in older adults. |
Test | Description | Notes |
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Blood Tests | Raised WCC, ESR, CRP may indicate active infection or inflammation. | Monitor inflammatory markers during exacerbations. |
CXR | May show tram tracks, ring shadows, or honeycomb patterns in advanced disease. | Less sensitive than HRCT for diagnosing bronchiectasis. |
High-Resolution CT (HRCT) Scan | Gold standard for diagnosis; shows airway dilation, wall thickening, mucus plugging, and tree-in-bud pattern. | Allows assessment of disease extent and severity. |
Spirometry | Measures lung function, specifically FEV1 and FVC to assess obstruction. | Used to monitor lung function over time and assess response to treatment. |
Sputum Culture | Identifies bacteria, fungi, and mycobacteria. | Guides antibiotic choice for exacerbations and chronic suppression therapy. |
Aspergillus Precipitins | Tests for antibodies against Aspergillus in patients with suspected ABPA. | Positive in ABPA and may require antifungal therapy. |
Bronchoscopy | Allows direct visualization of airways and sampling of secretions. | Useful in cases of suspected malignancy, foreign body, or localized bronchiectasis. |
Genetic Testing | Tests for CFTR gene mutations or primary ciliary dyskinesia. | Indicated in patients with early-onset disease or family history. |
Pulmonary Function Testing | Includes lung volumes and diffusion capacity (DLCO). | Assesses overall lung function and aids in management decisions. |
Management Option | Description | Comments |
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Airway Clearance Techniques | Chest physiotherapy, postural drainage, and oscillating positive expiratory pressure (PEP) devices. | Essential to reduce mucus build-up and prevent infections. |
Bronchodilators | Short-acting beta agonists (SABA) and long-acting beta agonists (LABA) to open airways. | Beneficial in patients with coexisting asthma or COPD. |
Inhaled Corticosteroids (ICS) | May reduce inflammation in patients with asthma overlap or frequent exacerbations. | Not typically first-line for bronchiectasis alone. |
Long-term Antibiotic Therapy | For patients with frequent exacerbations (≥3/year) or chronic Pseudomonas infection. | Options include macrolides (azithromycin) or inhaled antibiotics (tobramycin, colistin). |
Vaccinations | Annual influenza and pneumococcal vaccinations. | Reduces risk of infections that can exacerbate bronchiectasis. |
Surgery | Localized disease or significant hemoptysis not responsive to medical management. | Resection of the affected lung area may be needed. |
Pulmonary Rehabilitation | Exercise, education, and support to improve physical conditioning. | Improves quality of life and reduces symptoms. |