Bronchiectasis : Diagnosis management and treatment

Ovid: Oxford Handbook of Clinical Medicine Pathology Chronic infection of the bronchi and bronchioles leading to permanent dilatation of these airways. Main organisms: H. influenzae; Strep. pneumoniae; Staph. aureus; Pseudomonas aeruginosa. Causes Congenital: CF; Young’s syndrome; primary ciliary dyskinesia; Kartagener’s syndrome. Post-infection: measles; pertussis; bronchiolitis; pneumonia; TB; HIV. Other: Bronchial obstruction (tumour, foreign body); allergic bronchopulmonary aspergillosis (ABPA p160); hypogammaglobulinaemia; rheumatoid arthritis; ulcerative colitis; idiopathic. Clinical features Symptoms: persistent cough; copious purulent sputum; intermittent haemoptysis. Signs: finger clubbing; coarse inspiratory crepitations, wheeze (asthma, COPD, ABPA). Complications: pneumonia, pleural effusion; pneumothorax; haemoptysis; cerebral abscess; amyloidosis. Tests Sputum culture. CXR: cystic shadows, thickened bronchial walls (tramline and ring shadows). HRCT chest: (p150) to assess extent and distribution of disease. Spirometry often shows an obstructive pattern; reversibility should be assessed. Bronchoscopy to locate site of haemoptysis or exclude obstruction. Other tests: serum immunoglobulins; CF sweat test; Aspergillus precipitins or skin-prick test. Management •Postural drainage should be performed twice daily. Chest physiotherapy may aid sputum expectoration and mucous drainage. •Antibiotics should be prescribed according to bacterial sensitivities. Patients known to culture Pseudomonas will require either oral ciprofloxacin or IV antibiotics. •Bronchodilators (eg nebulized salbutamol) may be useful in patients with asthma, COPD, CF, ABPA (p160). •Corticosteroids (eg prednisolone) for ABPA. •Surgery may be indicated in localized disease or to control severe haemoptysis.

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