Bronchiectasis

Outline

Background

Assessment

Presentation

• Chronic productive cough- large volume of sputum

• Recurrent LRTI

• Underlying cause: e.g. pertussis, infertility, joint pains, foreign travel

Examination

• Bi-basal inspiratory crackles- changes with coughing

• Finger clubbing

• Sputum pot, long term IV access e.g. portocath; underlying cause signs

Investigations

• CXR- clear

• High Resolution CT: enlarged bronchioles

• PFT: obstructive (rarely restrictive)

Diagnosis

Diagnostic criteria: enlarged bronchioles on CT (larger than neighbouring bronchial arteries)

Classification: (aetiology)

• Idiopathic

• Post infective

  • Acute- Whooping Cough, Lobar Pneumonia, Pulmonary Tuberculosis,

  • Recurrent/ chronic- Cystic Fibrosis, 

• Inflammatory: Rheumatoid Arthritis, IBD, ABPA

• Systemic: Kartagener's Syndrome, Yellow Nail Syndrome 

Management

Acute

• Infective exacerbations: two weeks antibiotics as per sputum cultures

  • Pseudomonas- nebulised antibiotics

Chronic

• MDT- Respiratory Consultant, PT- chest clearance, OT, psychologist, dietician, cardiothoracic surgeon

• Lifestyle- smoking cessation

• Medical- mucolytics: e.g. hypertonic saline, azithyromycin prophylaxis

• Surgical: lobectomy/ pneumonectomy, single/ double lung transplant

Disease Cycle

New Diagnosis

History

• Respiratory symptoms: sputum- colour + volumes, chest pain

• Previous TB, pertussis, mould (gardening)

• Infertility, GI symptoms, 

Investigations

• Baseline: FBC, U&Es, LFTs, CRP; ECG, CXR

• Underlying cause: HIV, Cystic Fibrosis if under 40 years, Aspergillosis & pneumococcal serology, immunoglobulins +- autoimmune disease

• Sputum sample- bacteria, fungus & mycobacterium

• HRCT- widening bronchioles > adjacent bronchial arteries; broncho-arterial ratio > 1.5

• Pulmonary Function Tests: obstructive pattern

Management

Pseudomonas colonisation associated with worse short term outcomes, therefore eradication is performed with nebulised antibiotics (tobramycin +/- short term antibiotics). 

Inhalers, prednisolone or mucloytics aren't used unless there is co-morbid COPD or asthma. 

Resources & References

Written in 2025