Bronchiectasis
- An irreversible dilation of the tracheobronchial tree, with destruction of the bronchial walls.
Causes and Incidence Bronchiectasis is caused by conditions that repeatedly damage the bronchial walls and interfere with clearance of bronchial secretions, such as cystic fibrosis, immune-deficiency diseases, repeated respiratory tract infections, tuberculosis, inhalation of noxious gases, repeated aspiration pneumonia, and complications of measles and pertussis. Rare congenital anomalies may also be a cause. The incidence has declined dramatically since the introduction of antibiotics. Children are most vulnerable, and the incidence is highest among Inuit and Maori populations.
Disease Process Repeated inflammatory and infectious processes slowly alter the structure of the bronchial walls, diminishing cilia and impairing the ability to clear secretions, increasing mucus production, reducing elasticity and muscular response, and causing permanent dilation of various areas in the tracheobronchial tree.
Symptoms The individual is often asymptomatic early in the disease. A chronic cough with sputum production is the most common presenting sign. Hemoptysis and recurrent pneumonia are also common, as are dyspnea, wheezing, and fatigue.
Potential Complications Pulmonary hypertension, right ventricular failure, and cor pulmonale are common complications with long-standing disease.
Diagnostic Tests
Clinical examination
Chronic cough, mucopurulent sputum, hemoptysis, moist rales, rhonchi
Sputum
Foamy with sediment; large number of WBCs
Radiology
Chest x-ray shows increased markings, honeycombing, tram tracking
Bronchography
Definitive diagnosis made with visualization of bronchiectatic areas
Treatments
Surgery
Bronchial resection for confined disease unresponsive to conservative therapy.
Drugs
Mucolytics to clear secretions; antibiotics to treat bacterial infection; bronchodilators to reduce dyspnea.
General
Chest physiotherapy with postural drainage to clear secretions; increase fluids, use vaporizer to liquefy secretions; avoid respiratory infections.
