Internal Diseases · MU Sofia

Theory · 3. Bronchiectatic disease

Covers bronchiectasis as a chronic condition of permanently dilated bronchi, then its acquired and congenital causes such as cystic fibrosis, primary ciliary dyskinesia and alpha-1 antitrypsin deficiency. It goes on to the symptoms, including three-layered sputum, and the physical signs, laboratory findings, and imaging, with HRCT as the gold standard and the signet ring sign. It closes with local and systemic complications and a checklist of when to suspect the disease.

Inside: 8 sections · 5 labelled pictures · 16 flashcards · 3 min

Topic 3 of 88 in the MU Sofia syllabus for Internal Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 8 sections, about 483 words (3 min of reading), with 16 flashcards.

In this note

  1. Bronchiectasis
  2. Definition
  3. Etiology
  4. Symptoms
  5. Physical Examination
  6. Laboratory Tests
  7. Instrumental Investigations
  8. Complications

Definition

A chronic pulmonary condition characterized by permanent and abnormal dilation of the bronchi and bronchioles, usually due to chronic infection or inflammation, resulting in impaired mucociliary clearance, mucus stasis, and recurrent infections.

Key distinguishing feature:

  • Three-layered purulent sputum (frothy, mucoid, purulent)
  • Irreversible bronchial dilatation seen on HRCT

Etiology

1. Acquired Causes (More common)

  • Post-infectious: Recurrent or severe infections (e.g., pneumonia, pertussis, measles, tuberculosis)
  • Obstruction: Foreign bodies, tumors, enlarged lymph nodes compressing bronchi
  • Chronic bronchitis/COPD: Long-term inflammation damages airway structure

2. Congenital Causes

  • Cystic fibrosis: Thick, sticky mucus → chronic obstruction & infection
  • Primary ciliary dyskinesia (e.g., Kartagener syndrome): Poor mucociliary clearance
  • Immunodeficiency disorders: e.g., IgA deficiency → recurrent infections
  • Alpha-1 antitrypsin deficiency: Predisposes to airway damage

Symptoms

  • Chronic cough with large-volume, mucopurulent sputum (especially in the morning)
  • Three-layered sputum:
  • Frothy top (air)
  • Mucous middle
  • Purulent base (neutrophil-rich pus)
  • Recurrent respiratory infections with fever
  • Occasionally haemoptysis – may be mild or massive
  • Halitosis (bad breath) – due to chronic sputum retention
  • Dyspnea – especially in advanced cases or with coexisting COPD
  • Fatigue, weight loss – chronic inflammation and infection

Bronchiectasis should be suspected in any patient with chronic productive cough not responding to standard treatment.

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