Practice Easily Missed?

Bronchiectasis

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c2766 (Published 14 July 2010) Cite this as: BMJ 2010;341:c2766
  1. Nick H T ten Hacken, associate professor, pulmonary department,
  2. Thys van der Molen, professor, general practitioner department
  1. 1University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, Netherlands
  1. Correspondence to: N H T ten Hacken n.h.t.ten.hacken{at}long.umcg.nl
  • Accepted 11 May 2010

Bronchiectasis is mostly an acquired bronchopulmonary disorder with abnormal thickening of the bronchial wall and dilation of central and medium sized bronchi, due to a vicious circle of transmural infection and inflammation with mediator release. Though many underlying conditions may induce or contribute to the development of bronchiectasis (table), it is idiopathic in about 50% of adults1 and 25% of children.2

View this table:

Causes of and conditions associated with bronchiectasis1

Case scenario

A 29 year old, non-smoking kindergarten teacher with mild asthma often visited her general practitioner with recurrent respiratory tract infections, which they both attributed to daily contact with her students. After seven courses of oral antibiotics in one year, the doctor requested sputum cultures. These showed Pseudomonas aeruginosa. Given this unusual result and her recurrent infections, he referred her to a lung physician, and high resolution computed tomography of her lung showed mild bronchiectasis, which was later found to be due to α1 antitrypsin deficiency.

How common is it?

The prevalence of bronchiectasis varies with time period and geography, due to differences in antibiotic prescription, availability of vaccinations, and prevalence of associated disorders. Additionally, the doctor’s alertness for bronchiectasis and the availability of sensitive diagnostic tools may affect reported prevalence. In the United States the prevalence of non-cystic fibrosis bronchiectasis among adults between 1999 and 2001 was estimated to be 51 per 100 000 population.3 The prevalence was higher among women than men (71 v 32 per 100 000) and increased markedly with age (4 per 100 000 for people aged 18-34 years v 272 per 100 000 for those aged 75 or …

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