Bronchiectasis

Introduction

Bronchiectasis is an abnormal and permanent dilatation of medium sized airway due to damage of their
walls.
This usually arises from repeated bacterial or viral infections which result in inflammation and destruction of the structural components of the bronchial tree.
It may be focal or diffuse.
Bronchiectasis has both congenital or acquired causes.
The most important cause is severe or
repeated respiratory infections.
Other causes include:

  • Cystic fibrosis
  • Other hereditary disorders e.g.vciliary dyskinesia
  • Immunodeficiency disorders
  • Autoimmune disorders e.g. rheumatoid disease, ulcerative colitis, Sjogren syndrome
  • Mechanical factors e.g. chronically enlarged lymph nodes with pressure effect, lung tumour
  • Inhaled toxic substances e.g. silica, cola dust, tobacco smoke.

Symptoms and clinical features of bronchiectasis

  • Persistent or recurrent cough
  • Purulent fetid sputum
  • Haemoptysis
  • Pleuritic chest pain

With or without a history of preceding pneumonic illness.

  • Digital clubbing
  • Crepitations, rhonchi and wheezes
  • Cor pulmunale and right ventricular failure in chronically hypoxic patients

Differential diagnoses

  • Pulmonary tuberculosis
  • Lung abscess
  • Chronic bronchitis
  • Bullous emphysema

Complications of bronchiectasis

  1. Massive haemoptysis
  2. Lung abscess
  3. Mycotic abscess
  4. Pulmonary amyloidosis
  5. Ventilatory failure
  6. Cor pulmunale and right ventricular failure

Investigations

  • Chest radiograph: cystic spaces with air fluid levels
  • Bronchography: saccular, cylindrical or varicose bronchial dilatations
  • CT scan (of the chest)
  • Bronchoscopy: biopsys of endobronchial lesion
  • Sputum microscopy, culture,
  • Ziehl Nielson microscopy
  • Ventilatory function test: obstructive pattern

Treatment for bronchiectasis

Treatment objectives

  1. Eliminate underlying pathology
  2. Improve mucus clearance
  3. Control infection
  4. Reverse airflow obstruction

Drug treatment

1. Empirical antibiotics in acute exacerbations

Amoxicillin

  • Adult: 500mg-1g orally every 8 hours for 5-7 days
  • Child: 40mg/kg orally in 3 divided doses daily

Cotrimoxazole

  • Adult: 960mg orally every 12 hours for 5 – 7 days
  • Child:
    • 6 weeks to 5months: 120mg orally every 12 hours for 5 – 7 days
    • 6months – 5years: 240mg every 12 hours for 5 – 7 days
    • 6-12years: 480mg every 12 hours for 5 – 7 days

Switch to appropriate antibiotics as soon as culture results are available.

2. Bronchodilators

Salmeterol

  • Adult: 2 puffs (50 μg) twice daily. Can be doubled in severe airway obstruction
  • Child: same as adult dose (for children > 4years)

Salbutamol

  • Adult: 1-2 puffs (100 200 μg) 3-4 times daily
  • Child: usually 100 μg (1puff) may be
    increased to 200 μg with more severe symptoms.

Supportive measures

  • Supplemental oxygen
  • Postural drainage or suction
  • Cessation of cigarette smoking

Notable adverse drug reactions, caution

  • Prescribers/ dispensers should consult product literature to confirm the strength of various aerosol preparations.
  • Salbutamol: palpitations, tremors,
    nervous tension, muscle cramps, sleep disturbances, tachycardia, peripheral vasodilation, hypotension.

Prevention of bronchiectasis

  • Avoidance of smoking
  • Timely and effective treatment of bacterial infections
  • Respiratory care during childhood measles