Bronchiectasis

Abstract A bronchiectatic lung contains permanently dilated subsegmental airways that are inflamed, tortuous, and often partially or totally obstructed with secretions. Pathogenesis involves airway inflammation which can cause further bacteria-driven host-mediated lung damage. Causes include developmental defects, damage caused by previous infection, immune deficiency, mucociliary clearance defects, and mechanical obstruction, but in many cases (40–60%) the cause is unknown. Bronchiectasis should be suspected when there is a history of persistent cough productive of sputum throughout the year, with chest infections leading to increased symptoms. About 80% of patients have upper respiratory tract symptoms. Clinical examination is often normal, although ‘classical’ severe cases show finger clubbing and widespread coarse crackles. Management involves the treatment of the specific underlying cause (when possible) and treatment of the bronchiectasis itself, with the most important elements being sputum clearance by physiotherapy and antimicrobials, which need to be given in high dose.