Learning objectives

• Describe the pathology, common causes, and symptoms of bronchiectasis
• Manage patients with bronchiectasis

Definition 

• Bronchiectasis is characterized by prolonged abnormal dilatation of bronchi with chronic inflammation
• patients are extremely productive of sputum with a predisposition to either chronic infection or colonization with intermittent acute episodes of infection

Causes

• Cystic fibrosis
• Tuberculosis
• Smoking
• COPD
• Asthma
• Childhood pneumonia or recurrent adult infections
• Bronchial catrillage deficiency
• Abnormal ciliary motility (Kartageners)
• Hypogammaglobulinaemia
• Immunodeficiency
• Inhaled foreign body
• Tumor

Signs & symptoms

• High sputum production: Severe bronchiectasis patients can produce up to 500 mL of purulent sputum per day, which gets dramatically worse during an acute exacerbation
• Hemoptysis from areas of severe inflammation
• Pulmonary hypertension and cor pulmonale may develop in long-standing disease
• Metastatic abscess formation can occur
• Amyloidosis (rare)

Treatment

• Chest physiotherapy with percussion and postural drainage
• Early intervention with antibiotics to prevent acute exacerbations

Anesthetic management

Suggested reading

• Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
• Chalmers, J.D., Chang, A.B., Chotirmall, S.H. et al. Bronchiectasis. Nat Rev Dis Primers 4, 45 (2018).