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Bronchiectasis - Coggle Diagram

- - - - Congenital defects of the large airways are also associated with bronchiectasis. These include:
      - Williams–Campbell syndrome (bronchial cartilage deficiency).
      - Marfan's syndrome.
      - Mounier-Kuhn syndrome (tracheobronchomegaly).
      - Young's syndrome.
- - - - Dyspnoea (60% of people).
        
        Fever.
        
        Fatigue, reduced exercise tolerance.
        
        Haemoptysis that can be frank (up to 10 mL) or massive (more than 235 mL) (26–51.2%).
        
        Rhinosinusitis.
        
        Weight loss.
        
        Chest pain that is present between exacerbations and is usually non-pleuritic (19–46.3% of people).
        
        Sputum colonization with P. aeruginosa.
        
        Young age at presentation.
        
        History of symptoms over many years.
        
        Absence of smoking history.
        
        Daily expectoration of large volumes of purulent sputum (75% of people).
    - - Coarse crackles, especially in the lower lung zones.
      - Wheeze.
      - High-pitched inspiratory squeaks.
      - Large airway rhonchi (low pitched snore-like sounds).
      - Palpable chest secretions on coughing or forced expiratory manoeuvre, persisting over time.
      - Finger clubbing
      - CHILDREN
        
        A chronic moist or productive cough unresponsive to 4 weeks of antibiotics, especially between viral colds, or with positive sputum cultures for Staphylococcus aureus, Haemophilus influenza, P. aeruginosa, non-tuberculosis mycobacteria, or Burkholderia cepacia complex.
        
        A recurrent or persistent wet cough (over 6 weeks' duration).
        
        Asthma that does not respond to treatment.
        
        An episode of severe pneumonia, especially if symptoms, physical signs, or radiological changes do not completely resolve.
        
        Recurrent pneumonia.
        
        Persistent and unexplained physical signs or chest radiographic abnormalities.
        
        Localized chronic bronchial obstruction.
        
        Respiratory symptoms and structural or functional disorders of the oesophagus and upper respiratory tract.
        
        Unexplained haemoptysis.
        
        Exertional breathlessness.
- - - - Infective exacerbations and chronic bacterial colonization.
      - Approximately 50% of people will have two exacerbations per year and one-third require hospitalization per year.
      - There is an increased risk of mortality (up to 30%) after exacerbations, particularly in the presence of chronic obstructive pulmonary disease (COPD).
      - Haemoptysis — this can involve blood volumes of more than 250 mL and can be life-threatening.
      - Pneumothorax.
      - Respiratory failure.
      - Cor pulmonale.
        
        Chest pain.
        
        Coronary heart disease, ischaemic stroke.
        
        Anxiety and depression.
        
        Urinary incontinence.
        
        Fatigue and reduced exercise tolerance.
        
        Nutritional deficiency.
        
        Reduced quality of life — this is equivalent to the impact of severe COPD.
- - - - Oxygen saturation levels.
      - Full blood count including differential white cell count.
      - Other investigations — guided by clinical findings to confirm or rule out underlying causes for bronchiectasis.
      - Assess for the presence of anxiety or depression, particularly in people who have severe breathlessness. For more information, see the CKS topics on Generalized anxiety disorder and Depression.
      - Document the person's smoking history — if they currently smoke, offer support to stop. For more information, see the CKS topic on Smoking cessation.
      - Measure the person's weight and calculate and document the person's body mass index (weight in kg/height in m2).
        Refer all people with suspected bronchiectasis to a respiratory consultant for investigations to confirm the diagnosis and determine the underlying cause, and for appropriate treatment.