Alternate Names: Acquired bronchiectasis; Congenital bronchiectasis

Causes and Risks:

Bronchiectasis is often caused by recurrent inflammation or infection of the airways. It may be present at birth, but most often begins in childhood as a complication from infection or foreign body aspiration.

Cystic fibrosis causes about 50% of all bronchiectasis in the United States today. Recurrent, severe lung infections (pneumonia, tuberculosis, fungal infections), abnormal lung defenses, and obstruction of the airway by a foreign body or tumor are some predisposing factors.

Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis.

Prevention:

Prompt treatment of lung infections may reduce risk.

Symptoms:

• Chroniccough with large amounts of foul-smelling sputum production
• Coughing up blood
• Cough worsened by lying on one side
• Shortness of breath worsened by exercise
• Weight loss
• Fatigue
• Clubbing of fingers may be present (abnormal amount of tissue in the fingernail beds)
• Wheezing
• Skin discoloration, bluish
• Paleness
• Breath odor

Signs and Tests:

Chest auscultation reveals crackles or rhonchi usually in the lower lobes of the lungs.

Tests may include:

• A chest X-ray
• A chest CT
• A sputum culture
• A CBC, may reveal anemia and differential may show evidence of fungus infection
• A sweat test or other cystic fibrosis testing
• Serum Immunoglobulin analysis
• Serum precipitins (testing for antibodies to the fungus, aspergillus)
• A PPD (purified protein derivative) skin test for prior TB infection

Treatment:

Treatment is aimed at controlling infections, secretions, relieving airway obstruction, and preventing complications.

Regular, daily postural drainage to remove bronchial secretions is a routine part of treatment. A respiratory therapist can teach postural drainage and effective coughing exercises to affected people and their families.

Antibiotics, bronchodilators, and expectorants are often prescribed for infections. Childhood vaccinations and yearly influenza vaccine help reduce the prevalence of some infections. Avoidance of upper respiratory infections, smoking, and pollution may decrease susceptibility to infection.

Surgical lung resection may be indicated for those who fail to respond to therapy or for massive bleeding.

Prognosis:

With treatment, most people can lead normal lives without major disability.

Complications:

• Cor pulmonale
• Recurrent pneumonia
• Hemoptysis (coughing up blood)

• Symptoms worsen or do not improve with treatment
• There is a change in color or amount of sputum, or bloody sputum
• Chest pain or shortness of breath increases