> [!key points] > - consider in any patient with persistent productive cough ## Overview - cough, abnormal sputum production, and permanent dilation and thickening of the bronchi on imaging - cycles of trasmural infection and inflammation of bronchi and bronchioles - may be focal obstructive process of a segment or lobe, or a diffuse process involving most of both lungs **Exam** - coarse crackles on auscultation. usually lower zones, early inspiration - +/- wheeze - +/- clubbing CXR -- *poor sensitivity* ; may appear normal - coarse markings - honeycombing - focal pneumonitis, scattered opacities, atelectasis - bronchial wall thickening (ring shadows and tram lines) **associations** - [[COPD]], which is a major differential as well - severe lower resp infection - [[Tuberculosis|TB]] - CF - alpha 1 antitrypsin - RA - IBD - kartagener's syndrome (immotile cilia, sinusitis, situs inversus) - fibrotic lung disease - chronic purulent cough, recurrent localised pneumonia - recurrent aspiration pneumonitis - inhalation of noxious gasses - immune deficiency - congenital ## infective exacerbation - change in one or more symptoms of bronchiectasis - ↑ sputum vol or purulence - worsening dysponea - ↑ cough - ↓ lung f(x) - ↑ fatigue / malaise - new fever, pleurisy, or [[Haemoptysis]] **Organisms** sputum culture: - p aeruginosa 30% - s aureus 15% - H influenzae 10% ## management - supportive care - O2 - bronchial hygiene (postural drainage, chest physio, nebulised saline) - bronchodilators for COPD exacerbations - sputum mcs prior to abx - empirical abx against last isolated organisms - 1st line is amoxicillin 500mg Q8H for 2-3 weeks - doxy or clarithromycin, other macrolides if penicillin allergy - cipro 750mg Q12 H 7-14 days if pseudomonas - IV abx if failure of above or very sick - avoid long term abx due to resistance ; generally used if > 3 exacerbations per year