Bronchiectasis Signs and Symptoms

Definition

• An irreversible dilatation and destruction of the bronchi
• Results in airflow obstruction and impaired clearance of secretions
• Enhances susceptibility to bronchial infection and increases inflammatory reaction which causes further lung damage

Nguyên nhân

• Necrotizing infections that are not treated properly or untreated are a common cause of bronchiectasis in developing countries
• Typical offending organisms include Klebsiella sp, Staphylococcus aureus, Mycobacterium tuberculosis, Mycoplasma pneumoniae, non-tuberculous mycobacteria, measles, pertussis, influenza, herpes simplex and certain types of adenovirus
  • Mycobacterium avium complex (MAC) has propensity to occur in patients who are immunocompetent
  • Patients with chronic Pseudomonas aeruginosa colonization are at higher risk for complications

• Focal post-obstructive bronchiectasis may occur in endobronchial tumors, broncholithiasis, bronchial stenosis from infections, encroachment of hilar lymph nodes and foreign body aspiration
• Recurrent aspiration caused by gastroesophageal reflux disease (GERD) or dysphagia may be the cause of bronchiectasis in 1-11.3% of adult patients
• In adults, foreign body aspiration may occur with altered mental status and when food is not chewed
  • Chicken bone fragments may be the cause of lower respiratory tract obstruction in Chinese people from eating cooked meat on the bone

• Typically rare in non-white races
• Autosomal recessive multi-system disorder affecting the chloride transport system in exocrine tissues
• Bronchiectasis is the major pulmonary finding of this disease, occurring secondary to mucous-plugged proximal airways and chronic respiratory infection

• Rare but can cause poor mucociliary clearance, recurrent respiratory infections and bronchiectasis
• Kartagener’s syndrome which is characterized by situs inversus, bronchiectasis, chronic sinusitis with immotile cilia

• Hypersensitivity reaction to inhaled Aspergillus antigen that is characterized by bronchospasm, bronchiectasis, and immunologic evidence of a reaction to Aspergillus sp
• Bronchiectasis is secondary to airway plugs of viscid secretions containing hyphae of Aspergillus sp
• Computed tomography (CT) scan of chest reveals central airway bronchiectasis

• Syndrome clinically similar to CF
• Patients have the triad of bronchiectasis, sinusitis and obstructive azoospermia

• Congenital or acquired immunodeficiency usually present with repeated sinus or pulmonary infections
• Bronchiectasis in acquired immunodeficiency syndrome (AIDS) has occurred with or without obvious preceding pulmonary infections

• Pathogenesis of bronchiectasis in these conditions is unclear and may represent only coincidental findings
• Patients with A1AT deficiency make-up <1% of the population with bronchiectasis
• Individuals whose etiology is connected to rheumatoid arthritis account for only 2-5% of patients with bronchiectasis

• Distortion of the airways secondary to distortion of the lung parenchyma from pulmonary fibrosis

Signs and Symptoms

• Cough with chronic sputum production with recurring infective exacerbations and hemoptysis

• Rattly cough producing sputum after colds only
• Sputum production of <10 mL/day
• Change of position may cause sputum production
• May cause mild hemoptysis
• Well patient

• Constant rattly cough
• Sputum production of 10-150 mL/day
• Sputum production most of the time
• Occasional hemoptysis
• May have foul smelling breath
• Usually well patient

• Production of large volumes of sputum
• Sputum production of >150 mL/day
• Occasional pleural pain and hemoptysis
• Usually unwell patient
• May develop respiratory failure

Symptoms of Exacerbation

• Recognizing acute exacerbation generally depends upon symptomatic changes rather than any specific lab result
• Identification of acute exacerbation may be difficult since the onset may be gradual with sputum volume increasing slowly over months
• Acute bacterial infections are usually indicated by increased sputum production with enhanced viscidity, often with lassitude, shortness of breath and pleuritic chest pain
• Fever and chills are generally absent and chest X-ray rarely shows new infiltrates