Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

For further information, see CMDT Part 9-07: Bronchiectasis

Key Features

Essentials of Diagnosis

  • Chronic productive cough with dyspnea and wheezing

  • Radiographic findings of dilated, thickened airways and scattered, irregular opacities

General Considerations

  • A congenital or acquired disorder of large bronchi characterized by abnormal dilation and destruction of bronchial walls

  • May be localized or diffuse

  • May be caused by recurrent inflammation or infection

  • Cystic fibrosis causes 50% of all cases

  • Other causes

    • Infection

      • Tuberculosis

      • Fungal

      • Abscess

      • Pneumonia

    • Immunodeficiencies

      • Congenital or acquired hypogammaglobulinemia

      • Common variable immunodeficiency

      • Selective IgA, IgM, and IgG subclass deficiencies

      • AIDS

      • Lymphoma

      • Plasma cell myeloma

      • Leukemia

    • α1-Antitrypsin deficiency

    • Primary ciliary dyskinesia

    • Rheumatic diseases

      • Rheumatoid arthritis

      • Sjögren syndrome

    • Localized airway obstruction

      • Foreign body

      • Tumor

      • Mucoid impaction

Clinical Findings

Symptoms and Signs

  • Chronic cough with production of copious, purulent sputum

  • Hemoptysis

  • Pleuritic chest pain

  • Dyspnea

  • Weight loss

  • Crackles at the lung cases and wheezing

  • Obstructive pulmonary dysfunction with hypoxemia seen in moderate or severe disease

  • Haemophilus influenzae is the most common organism recovered from non-cystic fibrosis patients with bronchiectasis

  • Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus are commonly identified; non-tuberculous mycobacteria are seen less commonly

Differential Diagnosis

  • Chronic obstructive pulmonary disease

  • Asthma

  • Bronchiolitis

  • Allergic bronchopulmonary mycosis

Diagnosis

Laboratory Tests

  • Immunoglobulin quantification

  • Testing for cystic fibrosis

  • Sputum culture, including for nontuberculous mycobacteria

Imaging Studies

  • Chest radiographs

    • Show dilated, thickened bronchi that may appear as "tram-tracks" or as ring-like markings

    • Scattered irregular opacities, atelectasis, and focal consolidation may be present

  • High-resolution CT scanning is the diagnostic test of choice

Treatment

Medications

  • Treatment of acute exacerbations consists of

    • Antibiotics

    • Inhaled bronchodilators

  • Handheld flutter valve devices may be as effective as chest physiotherapy in clearing secretions

  • Antibiotic therapy should be guided by sputum smears and prior cultures

  • If a specific bacterial pathogen cannot be isolated, then empiric oral antibiotic therapy for 10–14 days is appropriate

  • Common regimens include

    • Amoxicillin or amoxicillin-clavulanate

    • Ampicillin

    • A second- or third-generation cephalosporin

    • Doxycycline

    • A fluoroquinolone

  • For recurrent exacerbations,

    • Preventive macrolide therapy for 6–12 months has been found to decrease the frequency of exacerbations

    • Alternatively, a trial of inhaled antibiotics may be used

Therapeutic Procedures

  • Daily chest physiotherapy with postural drainage and chest percussion

  • Bronchoscopy may be needed to evaluate hemoptysis, remove retained secretions, and rule out obstructing lesions

  • Pulmonary angiography with embolization may be required to control massive hemoptysis

Outcome

Follow-Up

  • Monitor serial pulmonary function tests and sputum cultures

  • If patient is unresponsive to treatment, screen ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.