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For further information, see CMDT Part 9-08: Bronchiectasis
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Essentials of Diagnosis
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Chronic productive cough with dyspnea and wheezing
Radiographic findings of dilated, thickened airways and scattered, irregular opacities
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General Considerations
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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
Immunodeficiencies
Congenital or acquired hypogammaglobulinemia
Common variable immunodeficiency
Selective IgA, IgM, and IgG subclass deficiencies
AIDS
Lymphoma
Plasma cell myeloma
Leukemia
α1-Antitrypsin (α1-antiprotease) deficiency
Primary ciliary dyskinesia
Rheumatic diseases
Rheumatoid arthritis
Sjögren syndrome
Allergic bronchopulmonary aspergillosis (ABPA)
Localized airway obstruction
Foreign body
Tumor
Mucoid impaction
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Chronic cough with production of copious, purulent sputum
Hemoptysis
Pleuritic chest pain
Dyspnea
Weight loss
Crackles at the lung bases 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
Chronic infection with P aeruginosa is a marker for disease severity, frequent exacerbation, accelerated course, and rapid decline in lung function
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Differential Diagnosis
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Complete blood count with differential
Immunoglobulin quantification (IgG, IgM, IgA)
Testing for cystic fibrosis with sweat chloride level and/or mutation analysis of CFTR gene
Sputum cultures, including for bacteria, nontuberculous mycobacteria, and fungi
Additional testing, if appropriate, may include
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Treatment of acute exacerbations consists of
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
For recurrent exacerbations,