Bronchiectasis
Basics
Description
Bronchiectasis is an irreversible syndrome with typical symptoms of chronic productive cough and recurrent exacerbations and with characteristic findings on cross-sectional imaging of bronchial wall dilation and thickening.
Epidemiology
Incidence
- Overall annual incidence in U.S. adults estimated to be 29 cases per 100,000
- Widespread vaccination and improved recognition and treatment of childhood respiratory disease has led to decreased incidence among U.S. children.
- Incidence may be higher among indigenous or socioeconomically disadvantaged groups.
Prevalence
- Overall prevalence estimated to be 139 per 100,000 among U.S. adults
- Higher among women (180 per 100,000) than men (95 per 100,000)
- Prevalence increases with age: 562 per 100,000 among U.S. seniors aged >65 years
- Global estimates of prevalence in children ranges from 0.2 to 735 cases per 100,000.
- Large variability exists among different populations of children.
- Populations with higher prevalence include children with primary immune deficiencies, chronic aspiration, primary ciliary dyskinesia, airway malformations, and children in low-income countries.
Etiology and Pathophysiology
- Bronchiectasis is sometimes identified as an isolated pulmonary diagnosis.
- Often arises as a complication of other inherited or acquired disease states
- Vicious cycle hypothesis:
- An initial pulmonary insult causes airway inflammation, dysfunction, and structural disease.
- Dysfunctional airways are further impaired in their ability to clear infections.
- A pattern of lung damage/inflammation and progressive airway dysfunction is established, leading to clinical decline.
- Neutrophil extracellular traps (NETs) and neutrophil elastase are thought to play an important role.
- Higher levels/activity of these markers correlate with disease activity and may serve as potential therapeutic targets (1).
Risk Factors
Conditions/exposures which cause impaired host defenses, altered tracheobronchial anatomy, airway inflammation, and airway clearance all predispose to development of bronchiectasis.
General Prevention
- Routine immunization against respiratory infections (pertussis, measles, Haemophilus influenzae type B (HIB), influenza, and Streptococcus pneumonia)
- Early recognition and treatment of conditions which can lead to bronchiectasis
- Genetic counseling for patients with inheritable conditions which predispose to bronchiectasis who wish to conceive
- Smoking cessation
Commonly Associated Conditions
- Prevalence of conditions associated with bronchiectasis based on U.S. data published in 2017:
- Pneumonia (68%)
- GERD (47%)
- Asthma (29%)
- Chronic obstructive pulmonary disease (COPD) (20%)
- Any rheumatologic disease (8%)
- Immunodeficiency (5%)
- History of tuberculosis (TB) (4%)
- Inflammatory bowel disease (3%)
- Primary ciliary dyskinesia (3%)
- Other conditions which have been associated with bronchiectasis include:
- Allergic bronchopulmonary aspergillosis (ABPA)
- Chronic rhinosinusitis
- Congenital abnormalities of the airways (e.g., tracheobronchomalacia)
- α1-Antitrypsin deficiency
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Citation
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/all/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/all/Bronchiectasis. Accessed December 9, 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/all/Bronchiectasis
Bronchiectasis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 December 09]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116092/all/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/all/Bronchiectasis
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
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