Bronchiectasis

Clinical Description

In bronchiectasis, the medium and smaller sized bronchi and bronchioles are damaged.

Their ciliated epithelium is destroyed by inflammation and scarring, which in a vicious cycle of infection and further scarring leads to permanent dilatation and bronchial wall thickening. The mucus lining of these airways become colonized by bacteria and generate copious amounts of purulent and often offensive sputum.

The disease, if not treated is characterized by frequent infective exacerbations with progressively worsening lung function.

Causes

• Childhood pneumonia e.g., whooping cough, post measles
• Post-pulmonary tuberculosis
• Chronic rhinosinusitis with post-nasal drip
• Asthma and COPD
• Fibrosing lung disease of any cause e.g., rheumatoid lung disease Immune deficiency states e.g., HIV infection, agammaglobulinemia.
• Inherited disorders e.g., cystic fibrosis, primary ciliary dyskinesia
• Allergic bronchopulmonary aspergillosis (ABPA)

Complications

• Frequent infective exacerbations
• Hemoptysis
• COPD

Signs and Symptoms

• Persistent cough over many months.
• Copious purulent sputum (offensive)
• Hemoptysis
• Fever, night sweats and weight loss
• Chest pain
• Clubbing
• Dull percussion note
• Bronchial breath sounds + Coarse crepitations

Investigations

• FBC, ESR
• Sputum: gram stain, ZN stain, GeneXpert, culture and sensitivity
• Chest X-ray
• CT scan of the chest
• Pulse oximetry

Treatment

Treatment objectives

• To treat infection.
• To aid sputum clearance
• To minimize cough and sputum production.
• To prevent exacerbations.
• To diagnose and treat underlying disorders

Non-pharmacological

• Chest physiotherapy - Postural drainage, Sputum clearance technique
• Breathing exercises
• Improve nutrition
• Encourage adequate fluid intake.
• Encourage physical exercise

Pharmacological

• Acute infective exacerbation
• -1st Line Treatment Amoxicillin + Clavulanic Acid, oral, 625mg 8 hourly or Adults 1 g 12 hourly for 14 – 21 days or alternatively doxycycline 200mg stat then 100mg 12 hourly PO and metronidazole 400mg 8 hourly

PO for 14 days