Causes

1. Infections: Measles, whooping cough, bronchitis, bronchiolitis, pneumonia, endobronchial tuberculosis, adenovirus, influenza and HIV infections can also predispose to bronchiectasis.
2. Bronchial obstruction: foregin body, tumour , lymph node.
3. Associated immune disorders: Ulcerative colitis, SLE, rheumatoid, disease, ABPA.

Symptoms

1. Persistent, recurrent cough and large quantity of purulent sputum production.
2. Haemoptysis (Coughing of blood).
3. Persistent coarse leathery crackles with or without bronchial breathing (associated consolidation).
4. Any combination of crackles, rhonchi and wheezes can occur.
5. Clubbing of fingers and toes are present.

Investigations

Sputum Examination
This is done for identifying the infecting organisms. Classically, a 3 layered sputum is seen (upper layer-frothy and watery, middle layer-turbid and mucopurulent, lower layer-purulent and opaque.)

CT chest

1. Airway dilatation-tram track or signet-ring sign
2. Lack of bronchial tapering-presence of tubular structures within 1 cm from pleural surface
3. Cysts
4. Bronchial wall thickening in dilated airways with inspissated secretions-tree in bud pattern.

Bronchography

It provides excellent visualisation of bronchiectatic airways, which helps in confirming diagnosis and for planning surgery.

Management

1. Control of infections by using appropriate antibiotics. The infections is mostly due to P. aeruginosa and H. influenzae and the antibiotics have to be continued for 10 days.
2. Improved clearance of tracheobronchial secretions by adequate hydration, chest physiotherapy with percussion, vibration and postural drainage. Mucolytics are also tried (adequate hydration, acetyl cysteine, bromhexine). Percussion therapy should not be attempted when the patient has haemoptysis.
3. Reversal of air flow obstruction by bronchodilators.
4. Surgery: Surgery is done only for localised disease when the remaining lung and/or the other lung is normal and when there is no systemic causal factor. Surgery is contraindicated in extremes of age and in bilateral extensive lesions.

Preventive Measures

1. Reversal of underlying immunodeficiency (administer gamma globulin)
2. Vaccination (Influenza/pneumococcal)
3. Smoking cessation