In bronchiectasis, the medium and smaller sized bronchi usually in the
lower lobes become diseased and dilated. Their ciliated epithelium is then
replaced by squamous cells. The mucus present becomes a site for chronic
infection with the formation of large amounts of purulent and often
offensive sputum.
CAUSES
· Childhood pneumonia such as whooping cough, post measles
· Post-pulmonary tuberculosis
· Chronic rhinosinusitis with post-nasal drip
· Fibrosing lung disease e.g. fibrosing alveolitis
SYMPTOMS
· Bouts of coughing over many months
· Copious offensive sputum (especially in the morning)
· Haemoptysis-in over one third of cases
140
DISORDERS OF THE RESPIRATORY SYSTEM
· Fever
· Chest pain
SIGNS
· Weight loss
· Fever
· Clubbing
· Crepitations
INVESTIGATIONS
· FBC
· Sputum culture
· Chest X-ray
· CT scan of the chest after specialist review
TREATMENT
Treatment objectives
· To reduce cough and sputum production
· To prevent infective exacerbations
Non-pharmacological treatment
· Postural drainage
· Breathing exercises
· Improve nutrition
Pharmacological treatment
(Evidence rating: C)
· Co-amoxiclav, oral,
Adults
1 g 12 hourly for 10-14 days
Children
>12 years; One 500/125 tablet 12 hourly
for 10-14 days
6-12 years; 5ml of 400/57 suspension 12 hourly for
10-14 days
1-6 years; 2.5ml of 400/57 suspension 12hourly for
10-14 days
1month-1 year; 0.25ml/kg body weight of 125/31
suspension 8 hourly for 10-14 days
< 1 month; 0.25ml/kg body weight of 125/31
suspension 8 hourly for 10-14 days
141
DISORDERS OF THE RESPIRATORY SYSTEM
Double the dose in severe infections
For patients allergic to penicillin:
· Azithromycin, oral,
Adults
500 mg once daily for 7 days
Children
10 mg/kg once daily for 7 days
REFER
Refer all suspected cases to hospital for confirmation, sputum culture
and sensitivity tests and specialist management.
