- Bronchiectasis is an irreversible dilatation of ≥1 airways accompanied by recurrent transmural bronchial infection/inflammation and chronic mucopurulent sputum production.
- It may be focal or diffused.
- Predominant age: most commonly presents in 6th decade of life
- Predominant sex: female > male (1)
- Incidence has decreased in the United States for two reasons:
- Widespread childhood vaccination against pertussis
- Effective treatment of childhood respiratory infections with antibiotics
- Among children, incidence may be higher in indigenous or socioeconomically disadvantaged group (2).
Etiology and Pathophysiology
- Frequently idiopathic
- Chronic infections (PTB), autoimmune disease, genetic causes (cystic fibrosis (CF)), chronic obstructive pulmonary disease (COPD), connective tissue disease, allergic bronchopulmonary aspergillosis (ABPA) (4)
- Vicious circle hypothesis: Transmural infection, generally by bacterial organisms, causes inflammation and obstruction of airways. Damaged airways and dysfunctional cilia foster bacterial colonization, which leads to further inflammation and obstruction.
- Nontuberculous mycobacterial infection is both a cause and a complication of non-CF bronchiectasis.
- Severe respiratory infection in childhood (measles, adenovirus, influenza, pertussis, or bronchiolitis)
- Systemic diseases (e.g., rheumatoid arthritis and inflammatory bowel disease)
- Chronic rhinosinusitis
- Recurrent pneumonia
- Aspirated foreign body
- Congenital abnormalities
- Routine immunizations against pertussis, measles, Haemophilus influenzae type B, influenza, and pneumococcal pneumonia
- Genetic counseling if congenital condition is etiology
- Smoking cessation
Commonly Associated Conditions
- Mucociliary clearance defects
- Primary ciliary dyskinesia
- Young syndrome (secondary ciliary dyskinesia)
- Kartagener syndrome
- Other congenital conditions
- α1-Antitrypsin deficiency
- Marfan syndrome
- Cartilage deficiency (Williams-Campbell syndrome)
- Pulmonary fibrosis, causing traction bronchiectasis
- Postinfectious conditions
- Bacteria (H. influenzae and Pseudomonas aeruginosa)
- Mycobacterial infections (tuberculosis [TB] and Mycobacterium avium complex [MAC])
- Whooping cough
- Aspergillus species
- Viral (HIV, adenovirus, measles, influenza virus)
- Immunodeficient conditions
- Primary: hypogammaglobulinemia
- Secondary: ABPA, posttransplantation
- Sequelae of toxic inhalation or aspiration (e.g., chlorine, luminal foreign body)
- Rheumatic/chronic inflammatory conditions
- Rheumatoid arthritis
- Sjögren syndrome
- Systemic lupus erythematosus
- Inflammatory bowel disease
- Yellow nail syndrome
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Domino, Frank J., et al., editors. "Bronchiectasis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/0.3/Bronchiectasis.
Bronchiectasis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/0.3/Bronchiectasis. Accessed June 10, 2023.
Bronchiectasis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/0.3/Bronchiectasis
Bronchiectasis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 June 10]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/0.3/Bronchiectasis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Bronchiectasis ID - 116092 ED - Domino,Frank J, ED - Baldor,Robert A, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/0.3/Bronchiectasis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -