Bronchiectasis is an uncommon disease, most often secondary to an infectious process, that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways.
Signs and symptoms
Clinical manifestations of bronchiectasis are as follows:
Cough and daily mucopurulent sputum production, often lasting months to years (classic).
Blood-streaked sputum or hemoptysis from airway damage associated with acute infection.
Dyspnea, pleuritic chest pain, wheezing, fever, weakness, fatigue, and weight loss.
Rarely, episodic hemoptysis with little to no sputum production (i.e., dry bronchiectasis)
Exacerbations of bronchiectasis from acute bacterial infections, may produce the following signs:
Increased sputum production over baseline.
Increased viscidity of sputum.
A foul odor of the sputum (occasional).
Low-grade fever (rare).
Increased constitutional symptoms (e.g., fatigue, malaise).
Increased dyspnea, shortness of breath, wheezing, or pleuritic pain.
Diagnosis
The diagnosis of bronchiectasis involves the following:
A compatible history of chronic respiratory symptoms (e.g., daily cough and purulent sputum production).
Sputum analysis may strengthen clinical suspicion.
Chest radiography is occasionally sufficient for confirming the diagnosis.
High-resolution computed tomography (HRCT) scanning is the standard test for diagnosis.
Tests to identify underlying illnesses include the following:
- Quantitative immunoglobulin levels, to exclude hypogammaglobulinemia
- Quantitative serum alpha1-antitrypsin (AAT) levels, to rule out AAT deficiency
- Aspergillus precipitins and serum total IgE levels, to diagnose ABPA
- Autoimmune screening tests
Management
Treatment modalities include the following:
- Antibiotics and chest physiotherapy are the mainstays
- Bronchodilators
- Corticosteroid therapy
- Dietary supplementation
- Oxygen (reserved for hypoxemic patients with severe disease)
- Hospitalization for severe exacerbations
- Surgical therapies
