Bronchiectasis

Introduction

If you break down the term bronchiectasis it literally means bronchial dilation. This makes perfect sense because bronchiectasis is a disease characterised by airways that have become abnormal distended which causes the classic SHIT clinical features. This stands for excessive sputum production, haemoptysis, recurrent infections and a tenacious cough that won’t go away.

The pathogenesis of this bronchial dilation is based on chronic inflammation which is triggered by pathogens colonising the airways. This leads to increased mucous production and bronchial damage which serves as a great nidus for more infections. As a result, a vicious cycle ensures where infection causes airway damage and inflammation which causes further infection.

However, there is often an underlying aetiology which can induce the disease. Some key causes can be remembered by the AA, BB, CC acronym. This stands for Alpha-1 antitrypsin deficiency, asthma, bacterial infections, bronchial obstruction from foreign bodies, cystic fibrosis, and COPD.

Finally, management is needed to HELP in 4 domains:

Although haemoptysis is common, massive bleeding requires urgent transfer to hospital. Bronchial artery embolization or lobectomy may be required.

Infective exacerbations can be managed with antibiotics, as per local guidelines. Long-term therapy using macrolides is appropriate if patients have more than three exacerbations per year. Moreover, steroids and bronchodilators are not useful unless the patient has other indications for them.

Lifestyle optimisation includes helping people with smoking cessation, reducing alcohol intake, providing immunisations and managing comorbidities.

Finally, pulmonary rehabilitation through exercise can help with reducing breathlessness. Additionally, airway clearance can be assisted using physical techniques and nebulised mucolytic agents.

the clinical features of this S,H,I,T disease.

Excessive sputum production is a cornerstone feature. Mucopurulent secretions are present in two-thirds of patients and is usually produced daily

Haemoptysis is typically mild and effects 50% of patients. However, massive bleeding is a life-threatening complication to be aware of.

Infective exacerbations are characterised by three changes:

Increased sputum volume
Increase sputum purulence
Increased cough

The tenacious cough itself is chronic. It’s present in most patients, for most days of the week and often worse when lying flat or on one side.

Just quickly, another key feature that you can look for is clubbing when physically examining a patient’s fingers.

To summarise with our mnemonics, bronchiectasis presents as a SHIT disease with sputum, haemoptysis, recurrent infections and a tenacious cough but we can help by managing haemoptysis, exacerbations, lifestyle optimisation and pulmonary rehabilitation.