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Pathogenesis and diagnosis of bronchiectasis
Educational aims
 
To describe the important factors involved in the pathogenesis of bronchiectasis. To define how a diagnosis of bronchiectasis is made.

P.T. King1 E. Daviskas2

Dept of Respiratory and Sleep Medicine/Dept of Medicine, Monash Medical Centre, Melbourne, and 2Dept of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, Australia.

Bronchiectasis is an important cause of respiratory morbidity but one that has generally had a low profile. The prevalence of this condition varies but is common in certain indigenous populations and, anecdotally, in developing nations. It also has been recently recognised to be an ongoing problem in developed countries. As bronchiectasis is heterogeneous with a large number of predisposing factors and, generally, a long clinical history, the pathogenesis has not been well defined. The combination of a microbial insult and a defect in host defence allow the establishment of persistent bronchial infection and inflammation leading to progressive lung damage. Lung function testing usually demonstrates a mild to moderate obstructive pattern, which arises from inflammation in the small airways. There are a number of risk factors associated with this condition, which is commonly idiopathic. The microbiology of bronchiectasis is complex and changes as the disease progresses. The diagnosis is made by a combination of clinical symptoms and high-resolution computed tomography (HRCT) demonstrating abnormal airway dilatation.

Correspondence P.T. King Dept of Respiratory and Sleep Medicine Monash Medical Centre 246 Clayton Road Clayton Melbourne Australia

Provenance Commissioned article, peer reviewed. Competing interests E. Daviskas is an employee of the South West Sydney Area Health Service that owns the patent relating to the use of mannitol for enhancing clearance of secretions and may benefit from royalties in the future. E. Daviskas owns selffunded shares in Pharmaxis Ltd and, in her capacity as an employee of the SSWAHS, consults for Pharmaxis Ltd.

Bronchiectasis is defined as permanent and abnormal dilatation of the bronchi and is a radiological/pathological diagnosis [1, 2]. It arises from chronic airway infection that causes airway inflammation and bronchial damage. The dominant symptom is a chronic productive cough. It is currently nearly always diagnosed using computed tomography scanning. Bronchiectasis is a condition that has had a relatively low profile. With the readily availability of computed tomography scanning, it has recently been recognised that it is a common and important cause of respiratory disease. This review will discuss the pathogenesis of non-cystic fibrosis bronchiectasis and the diagnosis of this condition

Bronchiectasis is a heterogeneous condition with a large number of potential aetiological factors and, generally, a very long clinical history. The pathogenesis is not well understood but can be considered in different areas, which will be discussed below. In studies of adults, bronchiectasis is commonly idiopathic.

The prevalence of bronchiectasis has not been defined. It was thought that the introduction of antibiotics would effectively mean that patients no longer developed bronchiectasis HERMES syllabus link: modules B.1.6

DOI: 10.1183/18106838.0604.342

Breathe  June 2010  Volume 6  No 4


Pathogenesis and diagnosis of bronchiectasis

Figure 1 Classification of bronchiectasis by REID [11]. a) Tubular (or cylindrical) bronchiectasis. This is characterised by smooth dilatation of the affected bronchus. Computed tomography demonstrates this with non-tapering of the bronchus. This is the dominant form currently seen. b) Varicose bronchiectasis. This is characterised by areas of focal narrowing along a dilated bronchus. c) Cystic bronchiectasis....
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