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Key Features

Essentials of Diagnosis

  • Chronic cough with sputum production

  • Rhonchi or wheezes (or both) on chest auscultation

  • Diagnosis is confirmed by high-resolution CT scan

General Considerations

  • Defined as the permanent dilation of bronchi resulting from airway obstruction by retained mucus secretions or inflammation in response to chronic or repeated infection

  • Occurs either as a consequence of

    • Preceding illness (severe pneumonia or foreign body aspiration) or

    • Manifestation of an underlying systemic disorder (cystic fibrosis, primary ciliary dyskinesia, chronic aspiration, or immunodeficiency)

Clinical Findings

  • Chronic cough, purulent sputum

  • Fever

  • Weight loss

  • Recurrent respiratory infections and dyspnea on exertion

  • Finger clubbing

  • Rales, rhonchi, and decreased air entry often noted over the bronchiectatic areas


Laboratory Findings

  • Most common bacteria detected in cultures from the lower respiratory tract include

    • Streptococcus pneumoniae

    • Staphylococcus aureus

    • Nontypeable Haemophilus influenzae

    • Pseudomonas aeruginosa

  • Nontuberculous mycobacterial species may also be detected


  • Chest radiographs

    • May be mildly abnormal with slightly increased bronchovascular markings or areas of atelectasis

    • May demonstrate cystic changes in one or more areas of the lung

  • High-resolution CT

    • Best method to define extent of bronchiectasis

    • Often reveals far wider involvement of lung than expected from the chest radiograph

Diagnostic Studies

  • Pulmonary function testing demonstrates airflow obstruction and air trapping

  • Evaluation of lung function after use of a bronchodilator is helpful in assessing the benefit from bronchodilators

  • Serial assessments of lung function help define the progression or resolution of the disease



  • Aggressive antibiotic therapy during pulmonary exacerbations and routine airway clearance is mainstay of treatmen

  • Prolonged antibiotic use, anti-inflammatory therapy, hyperosmolar agents (hypertonic saline), and bronchodilators have not proven effective in non–cystic fibrosis bronchiectasis, although individual patients may benefit

  • Prolonged azithromycin

    • Has been shown to reduce exacerbations in adults with non–cystic fibrosis bronchiectasis

    • Whether these results translate to children with idiopathic bronchiectasis is unknown


  • Removal of an area of lung affected with severe bronchiectasis is considered when the response to medical therapy is poor

  • Other indications for surgery include

    • Severe localized disease

    • Repeated hemoptysis

    • Recurrent pneumonia in one area

  • If bronchiectasis is widespread, surgical resection offers little advantage



  • Depends on the underlying cause and severity of bronchiectasis, the extent of lung involvement, and the response to medical management

  • Good pulmonary hygiene and avoidance of infectious complications in the involved areas of lung may reverse cylindrical bronchiectasis


Salerno  T  et al: Bronchiectasis and severe respiratory insufficiency associated with a new surfactant ...

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