Bronchiectasis
Bronchiectasis is permanent, abnormal dilatation of the bronchi with chronic inflammation and infection, leading to a clinical syndrome of chronic productive cough, recurrent chest infections and sometimes haemoptysis.
Treatment at a glance
- Daily airway clearance (physiotherapy) is the foundation
- Antibiotics for an exacerbation, chosen from the sputum culture: amoxicillin or doxycycline; ciprofloxacin for Pseudomonas; usually 14 days
Bronchiectasis
- Permanent dilation of bronchi and bronchioles caused by the destruction of smooth muscle and elastic tissue. It typically results from or is associated with chronic necrotizing infections.
- Bronchiectasis is not a primary disorder but is always secondary to persistent infection or obstruction.
- Bronchial obstruction : Caused by tumors, foreign bodies, or mucus impaction. It also complicates asthma and chronic bronchitis.
- Cystic fibrosis : Leads to widespread severe bronchiectasis due to obstruction by viscid mucus and secondary infections.
- Immunodeficiency states (especially immunoglobulin deficiencies): Result in recurrent bacterial infections.
Read this in Lung Pathology — Must-Know
Bronchiectasis
- Definition: Permanent bronchial dilation from destruction of muscle and elastic tissue due to chronic necrotizing infections
- Associations: Cystic fibrosis, Kartagener syndrome, bronchial obstruction
What our notes say
- Bronchiectasis is permanent, abnormal dilatation of the bronchi with chronic inflammation and infection, leading to a clinical syndrome of chronic productive cough, recurrent chest infections and sometimes haemoptysis. (Bronchiectasis)
- Parapneumonic effusion and empyema, lung abscess, sepsis and septic shock, respiratory failure and ARDS, pleurisy, pericarditis, lobar collapse, metastatic infection (meningitis, endocarditis, arthritis), bronchiectasis (long term). (Pneumonia)
- Differential: COPD, heart failure ("cardiac asthma"), GORD, vocal cord dysfunction, bronchiectasis, foreign body, PE. (Asthma)
- Exclude TB, bronchiectasis, cancer and asthma in a patient with chronic cough. (Bronchitis (Acute and Chronic))
- Bronchiectasis — Year 4 Internal Medicine (Respiratory) Notes (Bronchiectasis)
- Secondary lung abscess: arises on underlying disease: bronchial obstruction (tumour, foreign body), bronchiectasis, septic emboli, TB cavity, pulmonary infarction, immunosuppression. (Lung Abscess)
Study material on Bronchiectasis
- Bronchiectasis
- Lung Pathology — Must-Know
- Respiratory system pathology mcqs
- Examination of Respiratory system
- Respiratory System Pathology 1A
- Junior Clerkship in Internal Medicine (MBIM4100) main exam, Paper One: 31 January 2024
- General Clinical Examination: Revision Notes & Key Signs
- Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019
- Respiratory Medicine Question Bank: 15 Clinical MCQs
- pathology essays
- Respiratory Pathology
Practice questions on Bronchiectasis
A 41-year-old woman has episodic dyspnea with expiratory wheezes, elevated serum IgE, peripheral eosinophilia, sputum eosinophils, perihilar bronchiectasis on CXR, and detectable serum galactomannan. Most likely pathologic finding in her bronchi?
- ANCA-associated vasculitis
- Blastomycosis
- Invasive candidiasis
- Non-invasive aspergillosis
Answer: D. Elevated IgE + eosinophilia + galactomannan (Aspergillus cell wall component) + bronchiectasis + asthma exacerbations = allergic bronchopulmonary aspergillosis (ABPA). The fungus colonizes bronchi non-invasively. ---
Bronchiectasis in Kartagener syndrome results from
- Abnormal chloride transport causing viscid mucus
- Immunoglobulin deficiency causing recurrent infections
- Structural ciliary abnormalities impairing mucociliary clearance
- Chronic aspiration causing repeated necrotizing pneumonia
Answer: C. Kartagener syndrome involves structural ciliary abnormalities (autosomal recessive). Impaired mucociliary clearance leads to persistent infections, bronchial wall destruction, and bronchiectasis. ---
A patient with cystic fibrosis develops severe irreversible airway dilation. The pathogenesis of bronchiectasis in this setting involves
- Immune complex deposition in bronchial walls
- Viscid mucus causing obstruction followed by infection
- Ciliary structural defects impairing clearance
- Smooth muscle destruction by autoantibodies
Answer: B. In cystic fibrosis, abnormally viscid mucus causes bronchial obstruction, predisposing to recurrent infections. The combination of obstruction and chronic necrotizing infection leads to irreversible bronchiectasis. ---