Describe the overall etiology of bronchiectasis.
Bronchiectasis requires the combination of two important processes taking place in the bronchi: either local infection or inflammation along with either inadequate clearance of secretions, airway obstruction, or impaired host defenses. These processes result in the permanent dilation of airways.
Pulmonary infections (i.e., bacterial, viral, fungal), especially severe or chronic infections
Disorders of secretion clearance or mucous plugging
Cystic fibrosis (CF)
Primary ciliary dyskinesia (PCD)
Allergic bronchopulmonary aspergillosis (ABPA)
Smoking: associated with poor ciliary motility
Bronchial narrowing or other forms of obstruction
Other congenital and acquired conditions (e.g., congenital bronchiectasis, tracheomalacia, bronchogenic cyst)
Immunodeficiency (e.g., common variable immunodeficiency, hypogammaglobulinemia, HIV)
Chronic inflammatory diseases (e.g., rheumatoid arthritis, Sjogren syndrome, Crohn disease)
Primary prevention of bronchiectasis includes antibiotic control of bronchial and pulmonary infections in predisposed individuals.
What are clinical features?
Chronic productive cough (lasting months to years) with copious mucopurulent sputum ;
Crackles and rhonchi
Wheezing (due to obstruction from secretions, airway collapsibility, or a concomitant condition)
Hemoptysis: usually mild or self-limiting, but severe hemorrhage that requires embolization may occur
Nonspecific symptoms (i.e., fatigue, weight loss, pallor due to anemia)
Clubbing of nails (uncommon)
Exacerbations of bronchiectasis
Recurrent bouts of pneumonia and acute bacterial infection of sections of dilated bronchi
Frequently due to Pseudomonas aeruginosa
Increased production of mucous above baseline
Bronchiectasis should be suspected in patients with a chronic cough that produces large amounts of sputum.