Bronchiectasis
Definition
Bronchiectasis is a chronic disease of the lungs in which the bronchi (airways) become
permanently dilated and damaged due to chronic infection and inflammation.
This causes accumulation of mucus, frequent infections, and difficulty clearing secretions,
leading to chronic productive cough and breathlessness.
Causes
1. Post-infectious causes (most common)
Repeated lung infections (pneumonia, tuberculosis, whooping cough, measles,
influenza).
Childhood respiratory infections that scar airways.
2. Obstructive causes
Foreign body, tumor, or enlarged lymph nodes compressing bronchi.
3. Congenital / Genetic causes
Cystic fibrosis (abnormal mucus clearance).
Primary ciliary dyskinesia (Kartagener’s syndrome).
Alpha-1 antitrypsin deficiency.
4. Immunological causes
Immunodeficiency disorders (IgA or IgG deficiency).
Allergic bronchopulmonary aspergillosis (ABPA) – allergic reaction to fungal
infection.
5. Others
Chronic aspiration (food/fluid entering lungs).
Autoimmune diseases (rheumatoid arthritis, lupus).
Chronic obstruction from COPD or asthma.
Symptoms
Chronic productive cough (lasting months or years).
Thick, purulent (foul-smelling) sputum.
Recurrent chest infections that respond poorly to antibiotics.
Shortness of breath (dyspnea).
Wheezing and chest tightness.
Hemoptysis (coughing up blood) — due to inflamed blood vessels.
Fatigue, malaise, weight loss (in severe cases).
Clubbing of fingers — in long-standing disease.
Crackles (coarse crepitations) heard on chest examination.
Diagnosis
1. History & Physical Examination
o Persistent cough with sputum, repeated infections, finger clubbing.
2. Investigations
o Chest X-ray: shows ―tram-track‖ lines (parallel lines due to thickened bronchi).
o High-Resolution CT (HRCT) chest: gold standard — shows dilated bronchi
and ―signet ring‖ sign.
o Sputum culture: identifies infecting organism (e.g., Pseudomonas, H.
influenzae).
o Spirometry / Pulmonary Function Test (PFT): shows obstructive pattern.
o Blood tests: for infection markers, immunoglobulin levels.
o Bronchoscopy: to identify obstruction or collect samples if needed.
Treatment
1. Medication
Antibiotics – mainstay of treatment for infection:
o Oral (e.g., Amoxicillin, Azithromycin, Ciprofloxacin).
o IV (e.g., Ceftazidime, Piperacillin-Tazobactam) for severe infections.
o Long-term low-dose antibiotics in recurrent cases.
Bronchodilators – e.g., Salbutamol, Ipratropium (to open airways).
Mucolytics & Expectorants – e.g., Acetylcysteine, Guaifenesin (to loosen mucus).
Corticosteroids – in allergic or inflammatory types (e.g., ABPA).
Vaccination – influenza and pneumococcal vaccines to prevent infections.
Oxygen therapy – for chronic hypoxemia (low oxygen).
Immunoglobulin therapy – in immunodeficiency-related cases.
2. Surgery
Indicated in localized bronchiectasis not controlled by medication:
Segmental or lobar resection (lobectomy) – removing diseased lung part.
Embolization – to control massive hemoptysis (bleeding).
Lung transplant – in end-stage bilateral bronchiectasis or cystic fibrosis.
3. Physiotherapy (Chest Physiotherapy)
Extremely important for airway clearance and infection control:
Postural drainage – positioning the patient to drain mucus from affected lobes.
Chest percussion and vibration – loosens mucus for easier expectoration.
Active Cycle of Breathing Technique (ACBT) – a sequence of breathing control,
thoracic expansion, and forced expiration to clear airways.
Autogenic drainage – breathing technique to move secretions from small to large
airways.
Incentive spirometry – encourages deep breathing.
Pursed-lip breathing and diaphragmatic breathing – improve lung ventilation.
Physical exercise (walking, cycling) – enhances lung function and immunity.
Precautions / Prevention
Avoid smoking and pollution exposure.
Prompt treatment of respiratory infections.
Regular chest physiotherapy to clear mucus.
Stay hydrated – keeps mucus thin and easier to cough up.
Vaccination – annual influenza and pneumococcal vaccines.
Avoid irritants like fumes, chemicals, strong perfumes.
Good oral hygiene – reduces bacterial spread to lungs.
Regular follow-up with a pulmonologist.
Early management of chronic cough to prevent complications.