Summary on Bronchiectasis as inspired by Oxford.

1. INTERNAL MEDICINE
• RESPIRATORY SYSTEM
• BRONCHIECTASIS
Dr. Chongo Shapi (BSc.HB, MBChB).
Medical Doctor
4 March 2024 1
Dr. Chongo Shapi (BSc. HB, MBChB)

2. INTRODUCTION
• Chronic inflammation of the bronchi and
bronchioles leading to permanent dilatation
and thinning of these airways.
• Main causative organisms include:
a) H. influenzae
b) Strep. Pneumoniae
c) Staph. Aureus
d) Pseudomonas aeruginosa.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 2

3. CONT’
• Causes could be Congenital, post infection and
those classified as others.
• Congenital causes include: Cystic fibrosis (CF),
Young’s syndrome, primary ciliary dyskinesia, and
Kartagener’s syndrome
• Post infection causes include: Measles, pertussis,
bronchiolitis, pneumonia, TB and HIV.
• Others: Bronchial obstruction (tumour, foreign
body), allergic bronchopulmonary aspergillosis,
hypogammaglobulinaemia, rheumatoid arthritis;
ulcerative colitis, idiopathic.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 3

4. CLINICAL FEATURES
• Symptoms include:
a) Persistent cough
b) Copious purulent sputum
c) Intermittent haemoptysis.
• Signs include:
a) Finger clubbing
b) Coarse inspiratory crepitations
c) wheeze
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 4

5. COMPLICATIONS
• Some common complications include:
a) Pneumonia
b) Pleural effusion
c) Pneumothorax
d) Haemoptysis
e) Cerebral abscess
f) Amyloidosis.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 5

6. INVESTIGATIONS
a) Sputum culture.
b) CXR: Cystic shadows, thickened bronchial
walls (tramline and ring shadows)
c) HRCT chest: to assess extent and distribution
of disease.
d) Spirometry often shows an obstructive
pattern; reversibility should be assessed.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 6

7. CONT’
e) Bronchoscopy to locate site of haemoptysis,
exclude obstruction and obtain samples for
culture.
f) Other tests: Serum immunoglobulins; CF
sweat test; Aspergillus precipitins or skin-prick
test RAST and total IgE.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 7

8. MANAGEMENT
• Airway clearance techniques and mucolytics.
Chest physiotherapy and devices such as a flutter
valve may aid sputum expectoration and mucus
drainage.
• Antibiotics should be prescribed according to
bacterial sensitivities. Patients known to culture
Pseudomonas will require either oral
ciprofloxacin or suitable IV antibiotics.
• If ≥3 exacerbations a year consider long-term
antibiotics (may be nebulized).
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 8

9. CONT’
• Bronchodilators (eg nebulized salbutamol)
may be useful in patients with asthma, COPD,
CF,
• Corticosteroids (eg prednisolone) and
itraconazole for ABPA.
• Surgery may be indicated in localized disease
or to control severe haemoptysis.
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 9

10. THE END!
• YOU’VE GOT TO KNOW WHO YOU ARE IN THIS
WORLD. AND THEN YOU’VE GOT TO BE WHO
YOU ARE IN THIS WORLD, NO MATTER WHAT!
4 March 2024 Dr. Chongo Shapi (BSc. HB, MBChB) 10