Bronchiectasis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Bronchiectasis often presents with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production.
High-resolution chest computed tomography is the confirmatory test.
Diagnostic testing is geared toward identifying the underlying etiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process.
A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations. Antibiotics are used in three scenarios: to treat acute exacerbations, eradication of a first or new isolation of Pseudomonas aeruginosa, and long-term antibiotics to suppress chronic bacterial infection. Where possible, antibiotic choice should be based on culture and sensitivity from sputum samples.
Daily airway clearance is essential for treatment success.

Chest x-ray with dilated and thickened airways

From archives of Dr Sangeeta M. Bhorade; used with permission

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Mucus-impacted bronchi in a 36-year-old woman with allergic bronchopulmonary aspergillosis
Situs inversus (Kartagener syndrome) in a 19-year-old woman with focal bronchiectasis from primary ciliary dyskinesia
Chest x-ray with dilated and thickened airways
Chest x-ray with lack of normal tapering producing a tram line
Chest computed tomography scan with dilated and thickened airways and peripheral tree-in-bud pattern
Chest computed tomography scan with presence of signet ring on left
Signet ring signs in a 20-year-old woman with bronchiectasis
Severe cystic and varicose bronchiectasis in a 49-year-old man with idiopathic bronchiectasis and scoliosis

Citations

Key Articles

Chang AB, Fortescue R, Grimwood K, et al. European Respiratory Society guidelines for the management of children and adolescents with bronchiectasis. Eur Respir J. 2021 Aug;58(2):2002990.[Abstract][Full Text]
Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019 Jan;74(suppl 1):1-69.[Abstract][Full Text]
Polverino E, Goeminne PC, McDonnell MJ, et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J. 2017 Sep 9;50(3):1700629.[Abstract][Full Text]
O'Donnell AE. Bronchiectasis - a clinical review. N Engl J Med. 2022 Aug 11;387(6):533-45.[Abstract]
Hill AT, Barker AF, Bolser DC, et al. Treating cough due to non-CF and CF bronchiectasis with nonpharmacological airway clearance: CHEST Expert Panel Report. Chest. 2018 Apr;153(4):986-93.[Abstract][Full Text]
Smith D, Du Rand I, Addy CL, et al. British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease. Thorax. 2020 May;75(5):370-404.[Abstract][Full Text]

Referenced Articles

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