Bronchiectasis

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Bronchiectasis  is  a  progressive  respiratory  disease  characterized  by  permanent  dilatation  of  the  bronchi  and  associated  with  a  clinical  syndrome  of  cough,  sputum  production  and  recurrent  respiratory infections.  

Investigations  

FBP, ESR, Serum IgE and IgE to aspergillus, serum immunoglobulin (IgG, IgA, IgM) CXR, Sputum culture and sensitivity, CT-Chest (CT contrast if suspicion of PE/HRCT, bronchoscopy. 

Non-pharmacological Treatment 

• Physiotherapy and postural drainage
• Avoid smoking
• Airways clearance technique
• Pulmonary rehabilitation
• Respiratory care during childhood measles helps prevent the development of bronchiectasis in children

Pharmacological Treatment 

Consider  antibiotics  in  patients  with  bronchiectasis  with  >3  exacerbations  per  year (empirical  treatment while wait for culture and sensitivity). 

Adults: 

A: ciprofloxacin (PO) 500mg 12hourly for 10days 

AND 

A: metronidazole (PO) 400mg 8hourly for 10days 

Children: 

A: amoxicillin (PO) 40mg/kg in 2 divided doses for 7days 

AND  

A: metronidazole (PO) 7.5 mg/kg 8hourly for 5–7days 

If Pseudomonas aeruginosa suspicion (should be culture guided) 

D: ceftazidime (IV) 2g 8hourly for 14days 

OR

S: piperacillin + tazobactam (FDC) (IV) 4.5mg 8hourly for 14days 

AND 

D: itraconazole (PO) 100mg-200mg 12hourly 

Prevention of infection 

A: ciprofloxacin 500mg (PO) 24hourly for 7–14days 

OR 

A: erythromycin (PO) 250–500mg 24hourly for 7–14days