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Bronchiectasis is a disease characterized morphologically by the permanent dilation of bronchi and bronchioles, and clinically by recurrent or persistent bronchial infection and cough. Exacerbations of bronchiectasis are related to retained inflammatory secretions and bronchial sepsis. The condition is categorized according to the radiological appearance of the airways.

CAUSES

Bronchiectasis can present as a local process in one lobe or segment, or as a generalized process in both lungs. Previously, childhood pneumonia was the most common cause; however, bronchiectasis is now more commonly associated with systemic diseases. When focal disease is present, the cause may be intraluminal (eg. foreign body, broncholith or endobronchial tumor), or due to extrinsic compression of the airway by enlarged lymph nodes.

Mycobacterium avium complex infection is associated with bronchiectasis, particularly in women over the age of 60, and Aspergillus fumigatus can cause upper lobe bronchiectasis in asthmatics. Recurrent sepsis in patients with sinus disease is an important cause. Increasingly, bronchiectasis is seen in patients with adult acquired immunodeficiency syndrome and recurrent bronchial infections. It is associated with primary ciliary dyskinesia, humoral immunodeficiencies of IgG, IgM and IgA. IgG subclass deficiency has also been linked with to this condition. Cystic fibrosis is an important cause in both children and adults. Rheumatoid arthritis and inflammatory bowel disease have also been linked to bronchiectasis.

CLINICAL SYMPTOMS AND DIAGNOSIS

Most patients with bronchiectasis have a chronic cough with sputum production. The sputum is usually purulent and may be bloodstained. Bronchiectasis should be considered in patients who have persistent symptoms not responding to standard treatment, and in whom a Gram-negative organism, such as Pseudomonas aeruginosa, is found on sputum culture. Occasionally patients present with life-threatening haemoptysis. Wheezing and shortness of breath are common during exacerbations, and pleuritis may occur if distal pneumonia is present. Crackles and rhonchi are commonly heard, and a small proportion of patients (<5%) have clubbing of the fingers.

The test of choice for confirming the diagnosis of bronchiectasis is high-resolution computerized tomography (CT) scan of the chest, which allows clear visualization of the severity and distribution of the disease. Pulmonary function testing often reveals some associated airflow obstruction.

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