Etiology

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)

  • Kartagener syndrome

  • Smoking: associated with poor ciliary motility

• Bronchial narrowing or other forms of obstruction

  • COPD

  • Aspiration

  • Tumors

  • α1-antitrypsin deficiency

  • 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.

• Chronic productive cough (lasting months to years) with copious mucopurulent sputum ;

• Auscultation

  • Crackles and rhonchi

  • Wheezing (due to obstruction from secretions, airway collapsibility, or a concomitant condition)

  • Bronchophony

• Rhinosinusitis

• Dyspnea

• 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

  • Features

    • Increased production of mucous above baseline

    • Low-grade fever

Bronchiectasis should be suspected in patients with a chronic cough that produces large amounts of sputum.