Figures
- Figure 1
Radiological heterogeneity of bronchiectasis. Two patients are shown: a) a patient with moderate idiopathic bronchiectasis demonstrating predominantly cylindrical dilatation, and b) a patient with severe disease and Pseudomonas aeruginosa colonisation demonstrating widespread varicose and cystic bronchial dilatation.
- Figure 2
High-resolution CT scanning in a 27 year old patient with homozygous ΔF508 CF. Bilateral upper lobe bronchiectasis is evident, with mosaicism. The scan also showed extensive emphysema.
- Figure 3
Two images from the same individual with tracheobronchomegaly showing a) gross tracheal dilatation and b) severe central bronchiectasis.
- Figure 4
Venn diagram illustrating the overlap between COPD, asthma and bronchiectasis.
Tables
- Table 1
Selected causes of bronchiectasis with their reported prevalence
Aetiology of bronchiectasis Proportion of adult patients affected Typical clinical features Idiopathic 20–60% Variable presentation Post-infective 20–40% History of severe infection in the affected lobe(s) or historical infection# Post-TB <2% in developed countries
Dominant cause in Eastern Europe, Asia and possibly other regionsHistory of TB with cavitation and lung damage ABPA 1–10% History of asthma, sputum plugs, wheezing, response to corticosteroids and demonstration of specific allergy to Aspergillus
Central bronchiectasisCTD 1–10% Evidence of systemic CTD (most frequently rheumatoid arthritis) Immunodeficiency <5% May be evidence of nonpulmonary infections or unusual microorganisms CF <1% in “non-CF” adult clinics Upper lobe bronchiectasis, extrapulmonary features, male infertility, malabsorption
Isolation of P. aeruginosa, S. aureus or NTMPCD <2% but may be underestimated due to limited testing Middle or lower lobe disease, history of otitis media and rhinosinusitis, early age of onset Yellow nail syndrome <1% Yellow nails, pleural effusion Tracheobronchomegaly <1% Characteristic radiological appearance of tracheal dilatation and central bronchiectasis NTM infection 2–50% Middle lobe nodular bronchiectatic disease
More common in females
May be scoliosis, pectus excavatum and low BMIHIV infection <1% No characteristic phenotype Haematological malignancy <1% Frequent respiratory tract infections AATD <1% Paraseptal emphysema, airflow obstruction Inhaled foreign body <1% Single lobe disease COPD¶ 2–60% Mild bilateral lower lobe disease with empysema and history of cigarette smoking Asthma¶ 1–50% Not well described Gastro-oesophageal reflux or aspiration¶ N/A Bilateral lower lobe or isolated right lower lobe bronchiectasis
Not clearly identified as an aetiologyBMI: body mass index; N/A: not available. #: reverse causation and recall bias make these estimates unreliable; ¶: whether these are true causes of bronchiectasis is debated. Prevalence rate data were extracted from [1, 12, 15–19].
- Table 2
Bradford–Hill criteria for causality applied to the association between COPD, asthma and bronchiectasis
Bradford Hill criteria COPD Asthma Strength of association/effect size Some studies report strong associations but may have methodological limitations Strong association demonstrated Consistency/reproducibility Reported by several studies with most reporting a high prevalence Reported by several studies with most reporting a high prevalence Specificity Lacking, as there are often other possible causes present Lacking, as there are often other possible causes present Temporality Rarely demonstrated Rarely demonstrated Biological gradient Clearly demonstrated across multiple studies that as COPD becomes more severe bronchiectasis is more prevalent Some evidence that bronchiectasis is more common in more severe asthma Plausibility Both COPD and bronchiectasis are characterised by neutrophilic inflammation and share common features and therefore probably some common pathophysiology Strong association between bronchiectasis and ABPA proves an association with eosinophilic inflammation, therefore association with asthma is highly plausible Coherence Not fully testable Not fully testable Experiment Experimental models of COPD are generally poor and conclusions cannot be drawn Experimental models of asthma do not show features of bronchiectasis Analogy COPD fits the model of the vicious cycle of bronchiectasis, being characterised by airway inflammation, infection and airway damage Asthma fits the model of the vicious cycle of bronchiectasis, being characterised by airway inflammation, infection and airway damage
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- Article
- Abstract
- Abstract
- What is bronchiectasis?
- What causes bronchiectasis?
- What are the links with “traditional” airway diseases (COPD and asthma)?
- What is the clinical presentation of bronchiectasis?
- Clinical impact of bronchiectasis
- Clinical impact of CF
- Bronchiectasis and CF in Europe
- Bronchiectasis and CF in North America
- Bronchiectasis and CF in Asia
- Management
- Future directions
- Conclusion
- Footnotes
- References
- Figures & Data
- Info & Metrics