22nd February 2024

Aetiology

There are numerous triggers for the onset of bronchiectasis. These include mechanical bronchial obstruction, immune deficiency, mucociliary clearance defects, lung parenchymal disease and repeated post-infected damage. Causes of bronchiectasis include:

Mechanical obstruction

• Foreign body ingestion
• Post tuberculosis 
• Tumour

Post-infective parenchymal damage

• Recurrent bacterial infections including pertussis, measles, and aspiration pneumonia

Immune deficiency or overdrive

• Allergic bronchopulmonary aspergillosis
• Immunoglobulin deficiencies (IgA and IgG)
• HIV / malignancy

Mucociliary clearance defects

• Cystic fibrosis
• Kartagener Syndrome 
• Young syndrome

Kartagener syndrome is an autosomal recessive disorder characterised by situs inversus, bronchiectasis and chronic sinusitis. Symptoms manifest from A defect in the mucociliary escalator, resulting in patients with recurrent bacterial chest infections, otitis media, rhinosinusitis and infertility. Situs inversus is often identified on chest radiographs with dextrocardia seen as an incidental finding and does not have any clinical sequalae. Other signs of dextrocardia include ECG findings with positive P-wave and inverted T-wave in Lead I, tall R wave in aVR lead and poor R wave progression from Leads V1 – V6. 

Young syndrome is characterised by infertility due to azoospermia, rhinosinusitis and bronchiectasis. 

References

King PT. The pathophysiology of bronchiectasis. Int J Chron Obstruct Pulmon Dis. 2009;4:411-9. doi: 10.2147/copd.s6133. Epub 2009 Nov 29