Bronchiectasis is an irreversible widening or dilation of portions of the airways or bronchi resulting from damage to the bronchial wall. In other words, it’s a term used to describe the abnormal dilatation of bronchi.
Contents of the post
- Selected causes of bronchiectasis
- Treatment and prognosis
- Bronchiectasis life expectancy
- Additional information for professionals
- Clinical features
- References and further reading
- Bronchiectasis can result from several conditions that injure the bronchial wall directly or indirectly by interfering with its normal defenses against potentially harmful substances.
- The most common cause is severe respiratory infections.
- Immune deficiency disorders, hereditary disorders such as cystic fibrosis (a disorder in which abnormal mucus impairs the ability of cilia to clear the bronchi of the organisms that cause infections) and mechanical factors such as bronchial obstruction (caused by an inhaled object, a lung tumor or other disorders) may predispose a person to infections that lead to bronchiectasis.
- A small number of cases probably result from inhaling toxic substances that injure the bronchi, such as noxious fumes, gases, smoke (including tobacco smoke) and injurious dust (silica and coal dust).
- In bronchiectasis areas of the bronchial wall are destroyed and become chronically inflamed, ciliated cells are damaged or destroyed and secretions or mucus accumulate.
- Also, the bronchial wall becomes less elastic. The affected airways become wider and flabby and may develop outpouchings or sacs that may resemble tiny balloons.
- The increased mucus production promotes the growth of bacteria, often obstructs the bronchi, and leads to the pooling of infected secretions and further damage to the bronchial wall.
- The inflammation and infection can extend to small air sacs of the lungs (alveoli) and produce pneumonia, scarring and a loss of functioning lung tissue.
- In severe cases, scarring and a loss of blood vessels in the lungs can ultimately strain the right side of the heartas the heart rises to pump blood through the altered vessels.
- Also, inflammation and an increased number of blood vessels in the bronchial wall (which are fragile) can result in a person coughing up blood.
- Blockage of the damaged airways can lead to abnormally low levels of oxygen in the blood.
- Bronchiectasis may affect many areas of the lung or it may appear in only one or two areas.
- Typically, bronchiectasis causes the widening of medium-sized bronchi, but often smaller bronchi becomes scarred and destroyed.
- Occasionally, a form of bronchiectasis affecting larger bronchi occurs in allergic bronchopulmonary aspergillosis, a condition caused by an allergic response to Aspergillus fungus.
- Bronchiectasis can develop at any age of ten, the process begins in early childhood.
- However, symptoms may not appear until much later.
- In most people, symptoms begin gradually, usually after a respiratory infection and tend to worsen over the years.
- Most people develop a chronic cough that produces sputum.
- The amount and type of sputum depends on how extensive the disease is and whether there is complicating infection.
- Often the person has coughing spells only early in the morning and late in the day.
- Coughing up of blood is common and may be the first or only symptom.
- Recurrent fever or chest pain, with or without frequent bouts of pneumonia, may also occur.
- People with widespread bronchiectasis may develop wheezing or shortness of breath.
- They may also have chronic bronchiectasis, which occur more commonly in underdeveloped countries and in people who have cystic fibrosis, may impair breathing and the lungs ability to oxygenate the blood and rid the body of carbon dioxide, a condition called respiratory failure.
- Very severe bronchiectasis may also strain the right side of the heart and lead to cor pulmonale.
Selected causes of Bronchiectasis
- Respiratory infections
- Bacterial infections such as a whooping cough or infections caused by Klebsiella, Staphylococcus, or Pseudomonas.
- Fungal infection such as Aspergillosis.
- Mycobacterial infection such as tuberculosis.
- Viral infection such as influenza, adenoviral infection, respiratory syncytial virus infection or measles.
- Mycoplasma infection.
- Bronchial obstruction
- Inhaled object.
- Enlarged lymph glands.
- Lung tumor.
- Mucus plug.
- Inhalation injuries
- Injury from noxious fumes, gases or particles.
- Inhalation of stomach acid and food particles.
- Hereditary conditions
- Cystic fibrosis
- Primary ciliary dyskinesia, including Kartagener’s syndrome
- Marfan syndrome
- Immunologic abnormalities
- Immunoglobulin deficiency syndromes.
- White blood cell dysfunction.
- Complement deficiencies
- Certain autoimmune or hyper-immune disorders such as rheumatoid arthritis and ulcerative colitis.
- Other conditions
- Drug abuse such as Heroin abuse.
- HIV infection
- Young’s syndrome (obstructive azoospermia)
- Yellow nail syndrome (with lymphedema)
- Congenital causes
- Ciliary dysfunction syndromes
- Primary ciliary dyskinesia
- Kartagener’s syndrome
- Cystic fibrosis
- Primary hypogammaglobulinemia
- Ciliary dysfunction syndromes
- Acquired causes in adults
- Pulmonary TB
- Supportive pneumonia
- Bronchial tumors
- Allergic bronchopulmonary aspergillosis complicating asthma
- Acquired causes in children
- Primary TB
- Inhaled foreign object
- Doctors may suspect bronchiectasis because of a person’s symptoms or the presence of a condition thought to cause bronchiectasis.
- Tests are performed to confirm the diagnosis and assess the extent and location of the disease.
- Chest X-rays can often detect the lung changes caused by bronchiectasis, however , occasionally results are normal.
- Computed tomography is usually the most sensitive test to identify and confirm the diagnosis and to determine the extent and severity of the disease; these are important factors when surgical treatment is being considered.
- After bronchiectasis is diagnosed, tests are often performed to check for diseases that may be causing or contributing to it if they were not previously identified.
- Such tests may include measuring the immunoglobulin levels in blood, testing for HIV infection and other immune system disorders, measuring the salt levels in sweat (which are abnormal in people with cystic fibrosis) and examining nasal, bronchial or sperm specimens with a special microscope and other tests to determine if the cilia are structurally or functionally defective.
- When bronchiectasis is limited to one area: for example, a lung lobe or segment – doctors may perform bronchoscopy to determine an inhaled foreign objector lung tumor is the cause.
- Other tests may be performed to identify underlying diseases such as allergic bronchopulmonary aspergillosis or tuberculosis.
- Genetic testing for cystic fibrosis may be needed when there is a family history, repeated respiratory infections, or other suspicious findings in a child or young adult, even when other features of typical cystic fibrosis are absent.
- Early identification and treatment of conditions that tend to cause bronchiectasis may prevent the development of bronchiectasis or reduce its severity.
- More than half the cases of bronchiectasis in children can be accurately diagnosed and promptly treated.
- Childhood immunization against measles and whooping cough, appropriate use of antibiotics and improved living conditions and nutrition have significantly reduced the number of people who develop bronchiectasis.
- Annual influenza vaccines, use of pneumococcal vaccines and use of appropriate drugs early in the course of infections (such as pneumonia and tuberculosis) helps to prevent bronchiectasis or reduce its severity.
- Receiving immunoglobulin for an immunoglobulin deficiency syndrome may prevent recurring infections.
- In people who have allergic bronchopulmonary aspergillosis, the appropriate use of corticosteroids and perhaps the antifungal drug itraconazole may reduce the bronchial damage that results in bronchiectasis.
- Avoiding toxic fumes, gases, smoke and injurious dusts also helps prevent bronchiectasis or reduce its severity.
- Inhalation of foreign objects into the airways by children may be prevented by carefully watching what they put in their mouth.
- Additionally, avoiding oversedation from drugs or alcohol and seeking medical care for neurologic symptoms (such as impaired consciousness) or gastrointestinal symptoms (such as difficulty in swallowing and regurgitation or coughing after eating) may help to prevent aspiration.
- Also, drops of mineral oil or other oils should never be placed in the mouth or nose because they can be inhaled into the lungs.
Treatment and Prognosis
- Treatment of bronchiectasis is directed against eradicating infections, decreasing the buildup of mucus and inflammation, relieving airway obstruction and reducing complications such as coughing up of blood, low oxygen levels in the blood, respiratory failure and cor pulmonale.
- Drugs that suppress coughing may worsen the condition and should not be used.
- Infections are treated with antibiotics, bronchodilators and physical therapy to promote drainage of secretions.
- Sometimes antibiotics are prescribed for a long period to prevent recurring infections, especially in people who have cystic fibrosis.
- For inflammation and buildup of mucus, anti-inflammatory drugs such as inhaled corticosteroids and drugs that thin this pus and mucus may also be given, although the effectiveness of mucolytics is uncertain.
- To help drain the mucus, postural drainage and chest percussion are used.
- To detect and treat bronchial obstruction, bronchoscopy can be used before severe damage occurs.
- Rarely, a part of a lung needs to be surgically removed.
- Such surgery usually is an option only if the disease is confined to one lung, or preferably to one lung lobe or segment.
- Surgery may be considered for people who have recurrent infections despite treatment or who cough up large amounts of blood.
- Alternatively, a doctor may deliberately block a bleeding bronchial vessel by using a procedure called bronchial arterial embolization.
- If the person’s blood oxygen level is low, oxygen therapy may help prevent complications such as cor pulmonale.
- If the person has wheezing or shortness of breath, corticosteroids taken with or without bronchodilators often help.
- Respiratory failure if present, should be treated.
- Lung transplantation can be performed in certain people who have advanced bronchiectasis, mostly those who also have advanced cystic fibrosis.
- Five years survival rates as high as 65 to 75% have been reported when a heart-lung or a double lung transplantation is used.
- Pulmonary function as measured by the amount of air in the lungs and the rate and amount of air moving in and out of the lungs with each breath, usually improves within 6 months and the improvement may be sustained for at least 5 years.
- The overall prognosis for people with bronchiectasis depends on how well infection and other complications are prevented or controlled.
- Because other conditions diminish the effectiveness of prevention and treatment, people with these conditions tend to have a worse prognosis.
Bronchiectasis life expectancy
- In mild bronchiectasis there is no shortage of life expectancy.
- In very severe bronchiectasis, however, some patients die at a younger age because of their lung disease.
Additional information for professionals
- Granulation tissue, Squamous epithelium, and normal ciliated epithelium are the areas where bronchiectatic cavities are lined up.
- Inflammatory changes may be present in the deeper layers of the bronchial wall.
- Hypertrophy of the bronchial arteries may also be present.
- Fibrotic changes and chronic inflammatory changes can be present in the surrounding lung tissue.
- The symptoms of bronchiectasis are mentioned above as well as on the next tab.
- Physical signs in the chest may be unilateral or bilateral.
- If secretions are absent in the bronchiectatic airways and if the associated lobar collapse is also absent, there are no abnormal physical signs.
- Coarse crackles can be heard over the affected areas if there is a large amount of sputum in the bronchiectatic spaces.
- If lobar collapse is present, physical signs and symptoms depend on whether the proximal bronchus supplying the collapsed lung is blocked or not. If that bronchus is blocked, breathing sounds are diminished.
Symptoms which occurs due to the accumulation of pus in the dilated bronchi
- Chronic productive cough
- This is worse in the mornings.
- Also occurs with a sudden change in posture.
- Sputum is abundant in quantity and is continuously discharging pus in the advanced stage of the disease.
- Bad breath (halitosis) is a common accompanying symptom.
Symptoms which occurs due to inflammatory changes in lung and pleura surrounding the dilated bronchi
- Following symptoms can be observed when pneumonia occurs due to spread of infection
- Increased cough
- Increased sputum volume
- This pneumonia may be associated with pleurisy.
- Recurrent pleurisy often occurs in the same site in bronchiectasis.
- In bronchiectasis, hemoptysis is often recurrent in nature.
- This could be mild to severe.
- This is usually associated with sputum containing pus.
- An increase in the discharge of pus in the sputum can also be observed.
- In the case of dry bronchiectasis, hemoptysis may be the only symptom.
Symptoms related to general health
- In the advanced stage of the disease, sputum continuously discharges pus.
- Other symptoms include:
- Weight loss
- Lack of energy
- Low – grade fever
- Digital clubbing
Bacteriological and mycological examination of sputum
- A sputum culture may reveal Pseudomonas aeruginosa, fungi like Aspergillus and other Mycobacteria in addition to common respiratory pathogens.
- Resistant strains should be identified by repeating sputum culture at regular intervals and appropriate treatment should be advised or prescribed to the patient.
- Bronchiectasis is not evident (usually) on a chest X-ray.
- Thickened airway walls, cystic bronchiectatic spaces and associated areas of pneumonic consolidation or collapse may be visible in the advanced stages of the disease.
- Computed Tomography (CT) scan being more sensitive than the X-ray, shows thickened dilated airways.
Assessment of ciliary function
- This can be done by placing a small pellet of saccharin in the anterior portion of the nose.
- The patient can taste this saccharin pellet when it reaches the pharynx.
- Time taken for Saccharin pellet to travel from the anterior portion of the nose to pharynx is measured.
- This time should not exceed 20 minutes.
- In patients suffering from ciliary dysfunction syndrome, this time is greatly prolonged.
- Biopsy of the nose should be performed to assess ciliary beat frequency.
- Electron microscopy should be utilized to detect the structural abnormalities of the cilia.
“What Are the Signs and Symptoms of Bronchiectasis?”. NHLBI. June 2, 2014. Archived from the original on 23 August 2016. Retrieved 10 August 2016.
McShane, PJ; Naureckas, ET; Tino, G; Strek, ME (Sep 15, 2013). “Non-cystic fibrosis bronchiectasis”. American Journal of Respiratory and Critical Care Medicine. 188 (6): 647–56. doi:10.1164/rccm.201303-0411CI. PMID 23898922.
Maguire, G (November 2012). “Bronchiectasis – a guide for primary care”. Australian family physician. 41 (11): 842–50. PMID 23145413.
“What Is Bronchiectasis?”. NHLBI. June 2, 2014. Archived from the original on 10 August 2016. Retrieved 10 August 2016.
“Bronchiolitis obliterans”. GARD. 2012. Archived from the original on 21 January 2017. Retrieved 13 September 2016.
Schlesinger, C.; Meyer, C.; Veeraraghavan, S.; Koss, M. (Jan 1998). “Constrictive (obliterative) bronchiolitis: diagnosis, etiology, and a critical review of the literature”. Annals of Diagnostic Pathology. 2 (5): 321–334. doi:10.1016/S1092-9134(98)80026-9. PMID 9845757.
Xie, BQ; Wang, W; Zhang, WQ; Guo, XH; Yang, MF; Wang, L; He, ZX; Tian, YQ (2014). “Ventilation/perfusion scintigraphy in children with post-infectious bronchiolitis obliterans: a pilot study”. PLOS ONE. 9 (5): e98381. doi:10.1371/journal.pone.0098381. PMC 4031120 Freely accessible. PMID 24852165.
Lynch JP, 3rd; Weigt, SS; DerHovanessian, A; Fishbein, MC; Gutierrez, A; Belperio, JA (October 2012). “Obliterative (constrictive) bronchiolitis”. Seminars in respiratory and critical care medicine. 33 (5): 509–32. doi:10.1055/s-0032-1325161. PMID 23001805.
Lockey, Richard F.; Ledford, Dennis K. (2014). Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis. Oxford University Press. p. 111. ISBN 9780199918072. Archived from the original on 2017-09-08.
Gourtsoyiannis, Nicholas C.; Ros, Pablo R. (2005). Radiologic-Pathologic Correlations from Head to Toe: Understanding the Manifestations of Disease. Springer Science & Business Media. p. 154. ISBN 9783540266648. Archived from the original on 2017-09-08.
Centers for Disease Control and Prevention (2002). Fixed obstructive lung disease in workers at a microwave popcorn factory (7th ed.).
“Archived copy”. Archived from the original on 2016-09-15. Retrieved 2016-08-18.
Sam, Amir H.; James T.H. Teo (2010). Rapid Medicine. Wiley-Blackwell. ISBN 1-4051-8323-3.
“Activated charcoal bronchial aspiration”. Archived from the original on 5 July 2015. Retrieved 23 January 2016.
Bunawan H, Bunawan SN, Baharum SN, Noor NM (2015). “Sauropus androgynus (L.) Merr. Induced Bronchiolitis Obliterans: From Botanical Studies to Toxicology”. Evid Based Complement Alternat Med. 2015: 714158. doi:10.1155/2015/714158. PMC 4564651 Freely accessible. PMID 26413127.
Brant & Helms (1999). Fundamentals of Diagnostic Radiology. Baltimore: Williams & Wilkins. ISBN 0-683-30093-8.
Webb; et al. (2000). High Resolution CT of the Lung (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. ISBN 0-7817-0217-8.
Brown, Jay A. “Haz-Map; Information on Hazardous Chemicals and Occupational Diseases”. National Institutes of Health. Archived from the original on 2007-09-12.
Colby, T.V. (1998). “Bronchiolitis, Pathologic Considerations”. Am J Clin Pathology (109): 101–9.
California Department of Public Health Archived 2009-10-16 at the Wayback Machine.
Harber P, Saechao K, Boomus C (2006). “Diacetyl-induced lung disease”. Toxicol Rev. 25 (4): 261–272. doi:10.2165/00139709-200625040-00006. PMID 17288497.
“Preventing lung disease in workers who make or use flavorings”. National Institute for Occupational Safety and Health. 2004. Archived from the original on 2006-07-18.
Schachter, E. Neil (2002). “Popcorn Workers’ Lung”. New England Journal of Medicine. 347 (5): 360–1. doi:10.1056/nejme020064.
Egilman, David (2007). “Popcorn Workers Lung” (PDF). Archived (PDF) from the original on 2007-09-27.
Sauler, Maor; Gulati, Mridu (December 2012). “Newly Recognized Occupational and Environmental Causes of Chronic Terminal Airways and Parenchymal Lung Disease”. Clinics in Chest Medicine. 33 (4): 667–680. doi:10.1016/j.ccm.2012.09.002. PMC 3515663 Freely accessible. PMID 23153608.
“CDC – Flavorings-Related Lung Disease – NIOSH Workplace Safety and Health Topic”. www.cdc.gov. Archived from the original on 17 October 2015. Retrieved 15 October 2015.
Reuters New Report: FDA to probe popcorn link in man’s lung disease Archived 2007-12-27 at the Wayback Machine..
Man sues for “popcorn lung” by George Merritt, Associated Press Archived 2012-09-15 at the Wayback Machine. Online edition. Retrieved 29 April 2011.
Mark Jaffe (21 September 2012). “Centennial man with “popcorn lung” disease gets $7.3 million award”. The Denver Post. Archived from the original on 22 September 2012. Retrieved 22 September 2012.
“Europe takes ‘wait-and-see’ stance on diacetyl flavouring”. FoodNavigator.com. Archived from the original on 24 May 2008. Retrieved 18 December 2015.
“News Feed Researcher”. Retrieved 18 December 2015.
Weaver Popcorn Company Press Release: “Pop Weaver Introduces First Microwave Popcorn With Flavoring Containing No Diacetyl” Archived 2008-02-22 at the Wayback Machine., 2007-08-27, hosted at PRNewswire.com. “”Pop Weaver introduces first microwave popcorn with flavoring containing no diacetyl”” (PDF). Archived from the original (PDF) on 2007-09-28. (216 KiB)
Letter from Cecile Rose to U.S. Food and Drug Administration Archived 2007-09-27 at the Wayback Machine., from www.defendingscience.org
David Michaels (2007). Popcorn Lung Coming to Your Kitchen? The FDA Doesn’t Want to Know Archived 2007-09-09 at the Wayback Machine., a blog post at thepumphandle.wordpress.com
USA Today. ConAgra to drop popcorn chemical linked to lung ailment Archived 2011-12-28 at the Wayback Machine.
“Comments of the National Institute for Occupational Safety and Health to the Food and Drug Administration (FDA) in response to Establishment of a Public Docket; Electronic Cigarettes and the Public Health Workshop” (PDF). 5 August 2015. Archived (PDF) from the original on 1 March 2017. Retrieved 21 March 2017.
“CDC – Flavorings-Related Lung Disease: Exposures to Flavoring Chemicals – NIOSH Workplace Safety and Health Topic”. Archived from the original on 17 December 2015. Retrieved 18 December 2015.
http://www.usmedicine.com/compendium/where-theres-smoke-dod-investigates-causes-of-deployment-related-pulmonary-symptoms-reported-by-troops.html#.UsH-jNJDvSs Archived 2013-12-31 at the Wayback Machine.
Harrison Jacobs (5 November 2013). “Open-Air Burn Pits Leave Troops Sickly – Business Insider”. Business Insider. Archived from the original on 22 December 2015. Retrieved 18 December 2015.
“CDC – Flavorings-Related Lung Disease: Exposure Control – NIOSH Workplace Safety and Health Topic”. www.cdc.gov. Archived from the original on 2015-10-26. Retrieved 2015-10-22.
“Paper: Encouraging Results of a Phase II Trial of Inhaled Fluticasone Propionate, Azithromycin, and Montelukast (FAM) May Maintain Lung Function in Bronchiolitis Obliterans Syndrome (BOS) after Hematopoietic Cell Transplantation”. Archived from the original on 4 March 2016. Retrieved 18 December 2015.
Nicki R. Colledge; Brian R. Walker; Stuart H. Ralston, eds. (2010). Davidson’s principles and practice of medicine. illustrated by Robert Britton (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. ISBN 978-0-7020-3085-7.
“Quality Standards for Clinically Significant Bronchiectasis in Adults”. British Thoracic Society. July 2012. Archived from the original on 7 July 2017. Retrieved 29 April 2017.
“How Is Bronchiectasis Treated?”. NHLBI. June 2, 2014. Archived from the original on 28 July 2016. Retrieved 10 August 2016.
Corris, PA (Jun 2013). “Lung transplantation for cystic fibrosis and bronchiectasis”. Seminars in respiratory and critical care medicine. 34 (3): 297–304. doi:10.1055/s-0033-1348469. PMID 23821505.
Cottin, Vincent; Cordier, Jean-Francois; Richeldi, Luca (2015). Orphan Lung Diseases: A Clinical Guide to Rare Lung Disease. Springer. p. 30. ISBN 9781447124016. Archived from the original on 2016-08-21.
Brant, William E.; Helms, Clyde A., eds. (2006). Fundamentals of diagnostic radiology (3rd ed.). Philadelphia: Lippincott, Williams & Wilkins. p. 518. ISBN 9780781761352. Archived from the original on 2017-09-06.
Michael Filbin; Lisa M. Lee; Shaffer, Brian L. (2003). Blueprints pathophysiology II : pulmonary, gastrointestinal, and rheumatology : notes & cases (1st ed.). Malden, Mass.: Blackwell Pub. p. 12. ISBN 9781405103510. Archived from the original on 2017-09-06.
Brent, Andrew; Davidson, Robert; Seale, Anna (2014). Oxford Handbook of Tropical Medicine. OUP Oxford. p. 223. ISBN 9780191503078. Archived from the original on 2016-08-21.
Lee, AL; Burge, AT; Holland, AE (23 November 2015). “Airway clearance techniques for bronchiectasis”. The Cochrane Database of Systematic Reviews (11): CD008351. doi:10.1002/14651858.CD008351.pub3. PMID 26591003.
Kapur, N; Bell, S; Kolbe, J; Chang, AB (Jan 21, 2009). “Inhaled steroids for bronchiectasis”. The Cochrane Database of Systematic Reviews (1): CD000996. doi:10.1002/14651858.CD000996.pub2. PMID 19160186.
Corless, JA; Warburton, CJ (2000). “Surgery vs non-surgical treatment for bronchiectasis”. The Cochrane Database of Systematic Reviews (4): CD002180. doi:10.1002/14651858.CD002180. PMID 11034745.
Hill, Adam T; Pasteur, Mark; Cornford, Charles; Welham, Sally; Bilton, Diana (1 January 2011). “Primary care summary of the British Thoracic Society Guideline on the management of non-cystic fibrosis bronchiectasis”. Primary Care Respiratory Journal. 20 (2): 135–40. doi:10.4104/pcrj.2011.00007. PMID 21336465.
Hassan, Isaac (8 December 2006). “Bronchiectasis”. eMedicine Specialties Encyclopedia. Gibraltar: WebMD. Archived from the original on 8 July 2007. Retrieved 2007-06-22.
Allergic Bronchopulmonary Aspergillosis
Fowler, S. J.; French, J.; Screaton, N.J.; Foweraker, A.; Condliffe, A.; Haworth, C.S:; Exley, A.R.; Bilton, D. (2006). “Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics”. European Respiratory Journal. 28 (5): 1204–1210. doi:10.1183/09031936.06.00149805.
Lamari NM, Martins AL, Oliveira JV, Marino LC, Valério N (2006). “Bronchiectasis and clearence [sic] physiotherapy: emphasis in postural drainage and percussion”. Braz. J. Cardiovasc. Surg. (in Portuguese). 21 (2). doi:10.1590/S1678-97412006000200015.
Sheikh S, Madiraju K, Steiner P, Rao M (1997). “Bronchiectasis in pediatric AIDS”. Chest. 112 (5): 1202–7. doi:10.1378/chest.112.5.1202. PMID 9367458.
Ferguson HR, Convery RP (2002). “An unusual complication of ulcerative colitis”. Postgrad. Med. J. 78 (922): 503. doi:10.1136/pmj.78.922.503. PMC 1742448 Freely accessible. PMID 12185236.
Kaushik, VV; Hutchinson D; Desmond J; Lynch MP & Dawson JK (2004). “Association between bronchiectasis and smoking in patients with rheumatoid arthritis”. Annals of the Rheumatic Diseases. 63 (8): 1001–2. doi:10.1136/ard.2003.015123. PMC 1755104 Freely accessible. PMID 15249329.
Sperber, Miriam (2012). Diffuse Lung Disorders: A Comprehensive Clinical-Radiological Overview. Springer Science & Business Media. p. 205. ISBN 9781447134404. Archived from the original on 2017-08-28.
Morillas HN, Zariwala M, Knowles MR (2007). “Genetic Causes of Bronchiectasis: Primary Ciliary Dyskinesia”. Respiration. 74 (3): 252–63. doi:10.1159/000101783. PMID 17534128.
Dalrymple-Hay MJ, Lucas J, Connett G, Lea RE (1999). “Lung resection for the treatment of severe localized bronchiectasis in cystic fibrosis patients”. Acta Chir Hung. 38 (1): 23–5. PMID 10439089.
Handelsman DJ, Conway AJ, Boylan LM & Turtle JR (1984). “Young’s syndrome. Obstructive azoospermia and chronic sinopulmonary infections”. NEJM. 310 (1): 3–9. doi:10.1056/NEJM198401053100102. PMID 6689737.
Notarangelo LD, Plebani A, Mazzolari E, Soresina A, Bondioni MP (2007). “Genetic causes of bronchiectasis: primary immune deficiencies and the lung”. Respiration. 74 (3): 264–75. doi:10.1159/000101784. PMID 17534129.
WILLIAMS H, CAMPBELL P (April 1960). “Generalized Bronchiectasis associated with Deficiency of Cartilage in the Bronchial Tree”. Arch. Dis. Child. 35 (180): 182–91. doi:10.1136/adc.35.180.182. PMC 2012546 Freely accessible. PMID 13844857.
“Medical Problems and Treatments | The Marfan Trust”. The Marfan Trust. Archived from the original on 2010-09-22. Retrieved 2010-12-08.
Shin MS, Ho KJ (1993). “Bronchiectasis in patients with alpha 1-antitrypsin deficiency. A rare occurrence?”. Chest. 104 (5): 1384–86. doi:10.1378/chest.104.5.1384. PMID 8222792.
Catanzano, Tara (5 September 2005). “Primary Tuberculosis”. eMedicine Specialties Encyclopedia. Connecticut: WebMD. Archived from the original on 5 June 2007. Retrieved 2007-06-22.
John M Holbert. “Bronchiectasis Imaging”. Medscape. Archived from the original on 2017-08-15. Retrieved 2017-08-15. Updated: Oct 13, 2015
Miller, JC (2006). “Pulmonary Mycobacterium Avium-Intracellular Infections in Women”. Radiology Rounds. 4 (2).
Crofton J (1966). “Diagnosis and Treatment of Bronchiectasis: I. Diagnosis”. Br Med J. 1 (5489): 721–3 contd. doi:10.1136/bmj.1.5489.721. PMC 1844268 Freely accessible. PMID 5909486.
Onen ZP, Eris Gulbay B, Sen E, Akkoca Yildiz O, Saryal S, Acican T, Karabiyikoglu G (2007). “Analysis of the factors related to mortality in patients with bronchiectasis”. Respir Med. 101 (7): 1390–97. doi:10.1016/j.rmed.2007.02.002. PMID 17374480.
José, RJ; Brown, JS (October 2014). “Bronchiectasis”. British journal of hospital medicine (London, England : 2005). 75 Suppl 10: C146–51. doi:10.12968/hmed.2014.75.Sup10.C146. PMID 25289486.
Hnin, Khin; Nguyen, Chau; Carson, Kristin V.; Evans, David J.; Greenstone, Michael; Smith, Brian J. (2015-08-13). “Prolonged antibiotics for non-cystic fibrosis bronchiectasis in children and adults”. The Cochrane Database of Systematic Reviews (8): CD001392. doi:10.1002/14651858.CD001392.pub3. ISSN 1469-493X. PMID 26270620.
Otgün I, Karnak I, Tanyel FC, Senocak ME, Büyükpamukçu N (2004). “Surgical treatment of bronchiectasis in children”. J. Pediatr. Surg. 39 (10): 1532–6. doi:10.1016/j.jpedsurg.2004.06.009. PMID 15486899.
Elborn JS, Johnston B, Allen F, Clarke J, McGarry J, Varghese G (1992). “Inhaled steroids in patients with bronchiectasis”. Respir Med. 86 (2): 121–4. doi:10.1016/S0954-6111(06)80227-1. PMID 1615177.
Waknine, Yael (27 July 2005). “Orphan Drug Approvals: Bronchitol, Prestara, GTI-2040”. Medscape today for WebMD. Archived from the original on 5 December 2008. Retrieved 2007-06-22.
“Bronchiectasis, Chapter 4, Dean E. Schraufnagel (ed.)”. Breathing in America: Diseases, Progress, and Hope. American Thoracic Society. 2010. Archived from the original on 2017-04-15. Retrieved 2017-04-30.
McShane, PJ; Naureckas, E T; Tino, G; Strek, M E (2013). “Non–Cystic Fibrosis Bronchiectasis”. American Journal of Respiratory and Critical Care Medicine. 188 (6): 230–35. doi:10.1164/rccm.201303-0411CI. PMID 23898922.
Roguin, A (2006). “Rene Theophile Hyacinthe Laënnec (1781–1826): The Man Behind the Stethoscope”. Clin Med Res. 4 (3): 230–35. doi:10.3121/cmr.4.3.230. PMC 1570491 Freely accessible. PMID 17048358.
Wrong O (2003). “Osler and my father”. J R Soc Med. 96 (6): 462–64. doi:10.1258/jrsm.96.9.462. PMC 539606 Freely accessible. PMID 12949207.