Bronchioectasis is an irreversible obstructive lung disease caused by inflammation and infection of the bronchioles. It is caused by congenital conditions, post-infection, or other factors. Symptoms include persistent coughing that is worse at night and with posture changes, purulent sputum, intermittent hemoptysis, fever, and malaise. Signs include coarse crackles, reduced or absent breath sounds, wheeze, and clubbing. The disease results in destruction of alveolar vessel walls and scarring/fibrosis of the parenchyma, dilating airways as surrounding scar tissue contracts. Investigations include sputum culture, chest X-ray, CT scan, spirometry

1. Bronchioectasis
Bronchioectasisisanirreversibleobstructive lungdisease causedbyinflammationandinfectionf the
bronchioles.
It iscaused by
Congenital conditions (Cysticfibrosis,primaryciliarydyskinesia,Young'ssyndrome)
Post-infection ( TB,HIV,pneumonia,measles,bronchiolitis,pertusis)
Other(foreignbody, tumour,ulcerativecolitis,rheumatoidarthritis,idiopathic,
hypogammaglobulinamia)
Symptoms: coughing(persistentworse atnightandaggravatedbychangesinposture),purulent
copioussputum,intermittenthaemoptysis,feverandmalaise.
Signs : Bilateral/unilateral coarse crackles,reducedorabsentbreathsounds, wheeze,inspiratory
crepitationsand clubbing
Pathology: an obstructionresultsin destructionof the alveolarvessel walls andthe elastin
containedwithinthem.The destructionisthenfollowedbyscarringandfibrosingof the
parenchyma. Airwaysdilateasthe surroundingscartissue contracts.
The lowerlunglobes are mostseverelyaffectedleadingto poolingof the bronchial secretions
increasingthe riskof furtherinfections.
Investigations:
Sputumculture (identifybacterial organisms)
CXR (normallynormal,inadvanceddisease,youmaysee areasof thickenedairwaywalls,
cyst spacesand consolidation andcollapse)
HighresolutionCT(signetringappearance)
Spirometery (obstructivepattern)
Bronchoscopy (identifyobstructionpoint)
Serumimmunoglobulin
Sweatelectrolytetesting/geneotyping/mucociliaryclearance (excludeorprove CFas a
causal factor)
Management:
1) Postural chestdrain withchestphysiotherapy(teachpatienttolie downflatinordertohave chest
drain3 timesa day)

2. 2) Antibiotics
3) Corticosteroids(prednisalone)
4) Bronchodilators(Beta-2agonistse.g.salbutamol) helpful inpatientswithasthmaandCOPD
5) Surgery(rare,indicatedif bronchioectasislocalised)
Complications
1) Pneumonia
2) Abscessinlungor cerebral abscess
3) Pneumothorax
4) Haemoptysis
5) Amylodosis
6) Cor Pulmonale
7) Empyema
8) Pleural effusion
9) Pulmonaryfibrosis
NB> primaryciliarydyskinesiacanpresentwithmisscariagesdue tofemale beingunableto
transportfertilisedeggthroughfallopiantubestothe uterus.Thisis due tothe ciliabeingdamaged
and notfunctioningcorrectlyinprimaryciliarydyskinesia.