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Bronchiectasis is usually a secondary condition that develops from other respiratory diseases such as COPD or Cystic Fibrosis. Some cases can also be attributed to childhood infections, aspiration of foreign bodies or congenital conditions. It is characterised by chronic infection in the small airways that results in some parts of the lung becoming damaged, scared and dilated which allows for large amounts of mucous to accumulate in pockets (figure 4).

The following outlines the progression and associated signs and symptoms of bronchiectasis

  • Due to recurrent inflammation and infection in the airways some bronchi undergo abnormal dilation or widening leading to obstruction in the airways or a weakening of the muscle and/or elastic fibres in the bronchial walls
  • The enlargement of the bronchi creates increased difficulty in removing mucous secretions (which increase due to inflammation and infection) and large amounts of mucous pools in the widened spaces.
  • As seen with chronic bronchitis the mucous creates an excellent medium for growing bacteria and leads to large amount of infections causing irritation and inflammation to the airways
  • This results in a cycle of repeated inflammation and infection leading to more cilia to be lost, additional fibrosis and progressive obstruction.

Signs and symptoms

The significant sign of bronchiectasis is a chronic cough and the production of copious amounts of green/yellow mucous (up to 240mL a day). This is due to attempts by the body to remove the excessive accumulation of mucous. Other signs and symptoms include rales and ronchi in the lungs, foul breath (which is indicative of an active infection), dyspnoea and haemoptysis (often referred to as “dry bronchiectasis”). Patients may also present with warm skin and a bounding pulse on palpation due to vasodilation caused by hypercapnia.

bronchiectasis
Figure 4: Mucous buildup in bronchiectasis


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