Bronchiectasis?,”Bronchiectasis results when damage occurs to the bronchial walls from inflammation or infection. Airway damage leads to further infection. Etiologies include airway obstruction (eg, lung cancer), post infectious (eg, viral, tuberculosis), congenital (eg, cystic fibrosis, alpha-1 antitrypsin deficiency), and toxin exposure. Patients typically develop chronic (most days of the week) productive cough with mucopurulent sputum, dyspnea, hemoptysis, fatigue, and weight loss. In contrast to chronic bronchitis, bronchiectasis is more likely associated with a larger volume of sputum (> 100 mL/day), recurrent fever, hemoptysis, and Pseudomonas aeruginosa infections. Patients with chronic bronchitis usually complain of non purulent expectoration. Physical findings of bronchiectasis include crackles, rhonchi, and wheezes on lung examination. Chest X-ray is not sensitive or specific for diagnosis of bronchiectasis but can reveal nonspecific findings such as linear atelectasis, dilated and thickened airways, and irregular peripheral opacities. High resolution chest CT is preferred for diagnosis and can show bronchial dilation, lack of airway tapering, and bronchial wall thickening on CT scan. After bronchiectasis is confirmed with CT, all patients require sputum analysis for bacteria and mycobacteria (TB and atypical). Bronchoscopy is recommended for focal disease to evaluate airway obstruction. Treatment involves addressing the underlying etiology, corticosteroids and macrolides to reduce airway inflammation
and pharmacologic agents and chest physiotherapy to mobilize secretions. Exacerbations should be treated with antibiotics tailored to sputum micro results.”