Bronchiectasis lecture for medical students

1. Clinical manifestation and
diagnosis of bronchiectasis
Lt col Hanif Khan Safdar
Portorož – 9th May 2009

2. Bronchiectasis:
- refers to a permanent abnormal dilatation of
the bronchi and bronchioli, caused by recurrent
infections which destruct muscular and elastic
components of bronchial walls.

3. 1. Epidemiology
• approximately 40 /100.000 (est.)
• more in women
• more in elderly population
• more in societies with pure access to health care

4. 2. Etiologies
infection of the airway + susceptibility
Susceptibility:
1. airway obstruction
2. defect in host defence
3. impaired drainage
4. other

5. 2. Etiologies – airway obstruction
Innate:
• bronchomalacia
• tracheobronchomegaly
• bronchial cyst
• ectopic bronch
• pulmonary sequestration
• Yellow nail sy.
Acquired
• foreign body aspiration (children, ...)
• (benign) tumour
• hilar adenopathy (TBC, sarcoidosis)
• chronic bronchitis
• polychondritis
• mucus impaction (ABPA, ...)

6. 2. Etiologies – defect in host defense
Innate:
• IgG deficiency (agammaglobulinemia, subclass deficiency,...)
• IgA deficiency
• chronic granulomatous disease (dysf. NADPH oxidase)
Acquired
• AIDS / HIV
• malnutrition

7. 2. Etiologies – impaired drainage / other
Impaired drainage:
• CF
• Young’s sy.
• PCD
• Kartagener’s sy.
Other:
• RA, Sjoegren’s sy
• alpha – 1 antitrypsin deficiency
• GIT disorders (UC, Crohn, GERD)
• infections in childhood (pertussis, measles, bacterial pneumonia, TBC,
adenovirus, ...)
• inhalation of toxic fumes and dusts (NO2, lipoid pneumonia, acids,...)
Kartagener’s sy.

8. 3. Clinical findings
1. cough and mucopurulent sputum - months / years
2. dyspnea, wheezing, chest pain
3. recurrent “bronchitis” and frequent antibiotic courses
Cough 98%
Daily sputum 78%
Rhinosinusitis 73%
Dyspnea 62%
Hemoptysis 27%
Pleurisy 20%
Crackles 75%
Wheezing 22%
Digital clubbing 2%
*King PT et al. Respir Med 2006; 100: 2183.

9. 4. Diagnosis
The purpose of evaluation:
1. radiographic confirmation
2. potentially treatable causes?
3. functional assessment
Evaluation:
• history / examination
• laboratory testing
• radiographic imaging
• pulmonary function testing
• other testing

10. 4. Diagnosis – laboratory testing
1. CBC, differential BC
2. immunoglobulin quantitation (levels of IgG, IgM, IgA)
3. sputum culture (bact. / TBC / fungi)

11. 4. Diagnosis - CXR
dilated airways
thickened airway walls
irregular periph.
opacities (mucus)

12. 4. Diagnosis – Chest CT
dilated bronchi
bronchial wall
thickening
“tree – in – bud”
pattern
cysts
lack of tapering

13. Cylindrical bronchiectasis
4. Diagnosis – Chest CT

14. Varicose bronchiectasis
4. Diagnosis – Chest CT

15. Cystis / saccular bronchiectasis
4. Diagnosis – Chest CT

16. Traction bronchiectasis (fibrosis)
4. Diagnosis – Chest CT

17. 4. Diagnosis - distribution
1. central (perihilar) – ABPA
2. predominant upper lobe – CF, Young sy, post - TBC
3. middle /lower lobe – PCD
4. lower lobe – “idiopathic”

18. 4. Diagnosis - distribution
Post – TBC
bronchiectasis with
aspergilosis

19. 4. Diagnosis – lung function
• FEV1 – low
• FVC – normal or low
• TI – low (obstruction)
• hiperresponsive ness – often present

20. 4. Diagnosis – other tests
• bronchial biopsy (ciliary ultrastructure)
• bronchoscopy – obstructing lesion?
• aspergillus precipitins / antibodies
• serum IgE
• Ig subclasses
• alpha 1 – antitrypsin (concentracion / phenotype)
• RF
• ....

21. 5. Summary
1. clinical findings (cough & sputum)
2. radiographic confirmation
3. identification of treatable causes
4. functional assessment
are important for proper treatment plan.

22. P.S. – have you known...
... that the largest subgroup represent elderly women.
The prevalence of urinary incontinence is 47%,
compared with 10 – 12% in general population.
* Prys-Picard CO, Niven R. Urinary incontinence in patients with bronchiectasis. Eur Respir J 2006; 27: 866 - 7.