This case illustrates an atypical presentation of this disease and the diagnostic dilemma that the physician may be faced with. CASE PRESENTATION: A 39-year-old woman presented with chronic cough, haemoptysis and hoarseness of voice. [ncbi.nlm.nih.gov]

• Fever

  A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever. Bronchiectasis after Mycoplasma pneumoniae pneumonia. The patient was treated with azithromycin for 7 days. [ncbi.nlm.nih.gov]

  Tuberculosis Presenting features may be malaise, easy fatiguability, anorexia, weightloss, afternoon fever, cough and haemoptysis. [ndri.com]

  Although the patient generally feels well–without fever or pain—fatigue, weight loss, shortness of breath, and wheezing can also be present. Bronchiectasis can be treated in a number of ways, including antibiotics and chest physiotherapy. [msdmanuals.com]

  In advanced cases the sputum and breath may become foul-smelling, and the patient may suffer loss of appetite, anemia, fever, episodes of pneumonia, and a general lowering of resistance to infection. [medical-dictionary.thefreedictionary.com]

• Fatigue

  Other physical manifestations include chest pain, snoring, finger clubbing, fatigue, persistent cough, recurrent infection, and loss of appetite [3]. Stress incontinence can also be a result of excess coughing. [physio-pedia.com]

  Although the patient generally feels well–without fever or pain—fatigue, weight loss, shortness of breath, and wheezing can also be present. Bronchiectasis can be treated in a number of ways, including antibiotics and chest physiotherapy. [msdmanuals.com]

  A single session of oscillatory PEP therapy (Flutter) generated a similar level of fatigue as ACBT with GAD, but greater fatigue was noted with oscillatory PEP therapy compared to ACBT alone. [ncbi.nlm.nih.gov]

  We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019 [patientslikeme.com]

  Although the patient generally feels well – without fever or pain--fatigue, weight loss, shortness of breath and wheezing can also present. Bronchiectasis can be treated in a number of ways including antibiotics and chest physiotherapy. [blausen.com]

• Weight Loss

  In addition to the weight loss, she had suffered from a chronic cough secondary to bronchiectasis and had been investigated for a suspected gastrointestinal malignancy. [ncbi.nlm.nih.gov]

  Loss Fitness Food & Cooking Parenting Pregnancy Sex & Relationships Skin & Beauty Men's Health Home Balance Diet & Weight Loss Fitness Food & Cooking Parenting Sex & Relationships Children's Health Home Fitness Food & Cooking Parenting Pregnancy Health [web.archive.org]

  Although the patient generally feels well–without fever or pain—fatigue, weight loss, shortness of breath, and wheezing can also be present. Bronchiectasis can be treated in a number of ways, including antibiotics and chest physiotherapy. [msdmanuals.com]

  Although the patient generally feels well – without fever or pain--fatigue, weight loss, shortness of breath and wheezing can also present. Bronchiectasis can be treated in a number of ways including antibiotics and chest physiotherapy. [blausen.com]

• Hypoxemia

  Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality. [ncbi.nlm.nih.gov]

  Onen et al. [49] showed that, in NCFB, factors associated with higher mortality were advanced age, poor functional status, more severe disease based on radiographic findings, and evidence of hypoxemia or hypercapnia. [oxfordjournals.org]

  In advanced cases, hypoxemia and right-sided heart failure due to pulmonary hypertension may increase dyspnea. Hemoptysis, which can be massive, occurs due to airway neovascularization. [merckmanuals.com]

• Chills

  Symptoms of bronchiectasis The symptoms associated with bronchiectasis can vary from person to person, but they most often include the following: Daily coughing up yellow or green mucus Shortness of breath Chronic fatigue Fevers and/or chills Wheezing [lunginstitute.com]

  For example, a patient with tuberculosis may have bloody sputum, fever, chills, and night sweats. A person with Crohn's disease may have abdominal pain and diarrhea. Congenital bronchiectasis often becomes apparent because of recurrent pneumonia. [emedicinehealth.com]

• Cough

  Boodman, chicagotribune.com, "The girl who couldn't stop coughing," 5 Apr. 2018 Among the telltale symptoms: a persistent year-round wet cough, nasal congestion and frequent respiratory infections. [merriam-webster.com]

  Objective 24-h cough, health status (cough-specific: Leicester Cough Questionnaire LCQ and bronchiectasis specific: Bronchiectasis Health Questionnaire BHQ), cough severity and lung function were measured. [ncbi.nlm.nih.gov]

  Since mucociliary clearance is reduced to about 15% of normal, patients tend to cough more [3]. With treatment, patients are discouraged from coughing unless they are ready to expectorate. [physio-pedia.com]

  Expectorants and Mucus-Thinning Medicines Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus. Expectorants help loosen the mucus in your lungs. [nhlbi.nih.gov]

• Sputum Production

  Inhaled steroids may have a role in the management of bronchiectasis by reducing cough and sputum production. [ncbi.nlm.nih.gov]

  It is associated with chronic copious sputum production, and may be associated with an inherited ciliary dysfunction. The most immediate symptom is persistent coughing with sputum production. [medical-dictionary.thefreedictionary.com]

  Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis. [emedicine.medscape.com]

• Chronic Cough

  It is increasingly identified during investigations into chronic cough and is evident high resolution CT scanning. [ncbi.nlm.nih.gov]

  No longer mainly a complication after pulmonary infection with Mycobacterium tuberculosis, diverse disease processes and mechanisms have been demonstrated to result in the chronic cough, purulent sputum production, and airway dilation that characterize [oadoi.org]

• Hemoptysis

  Pulmonary hemangioma is a rare thoracic condition that can lead to hemoptysis. [ncbi.nlm.nih.gov]

  Hemoptysis is common and may occur in as many as 50% of patients. Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis. [emedicine.medscape.com]

• Productive Cough

  A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever. Bronchiectasis after Mycoplasma pneumoniae pneumonia. The patient was treated with azithromycin for 7 days. [ncbi.nlm.nih.gov]

  The key points are: Think of the diagnosis of bronchiectasis in adults and children who present with a chronic productive cough or unexplained haemoptysis, and in children with asthma which responds poorly to treatment High resolution computed tomography [doi.org]

• Failure to Thrive

  Steatorrhea and failure to thrive are also common features of CF. Immunodeficiency states that predispose the child to repeated lower respiratory tract infections are another common underlying cause of bronchiectasis. [clinicaladvisor.com]

  […] to thrive, enlargement or absence of lymphoid tissues, unexplained organomegaly, unexplained joint symptoms). [patient.info]

  There may be a history of: Failure to thrive. Recurrent lower respiratory tract infections. Symptoms of bronchiectasis include: Chronic cough — usually productive but may be unproductive. Wheeze. Haemoptysis (usually blood-streaked sputum). [web.archive.org]

• Cyanosis

  […] infections (whooping cough, pneumonia, measles) local disease (foreign body, adenoma, Tb) allergic bronchopulmonary aspergillosis (proximal bronchiectasis) CLINICAL FEATURES History chronic cough purulent sputum Examination fever cachexia sinusitis cyanosis [lifeinthefastlane.com]

  Signs: On general examination-Emaciation, cyanosis and clubbing-of fingers seen in advanced cases. On chest examination: Inspection: Retraction of Chest wall Palpation: Diminished thoracic expansion. [ndri.com]

  Depending up on the severity of disease and how long it has been present, other findings may include weight loss, cyanosis (a bluish color of the skin and the mucous membranes due to an insufficient level of oxygen), and right heart failure (manifested [emedicinehealth.com]

• Lip Cyanosis

  Signs and symptoms of serious lung infection include: a bluish tinge to the skin and lips (cyanosis) confusion a high temperature of 38C (100.4F) or above rapid breathing (more than 25 breaths a minute) severe chest pain that makes it too painful to cough [nhsinform.scot]

• Halitosis

  Clinical findings Halitosis, paroxysmal coughing, expectoration of mucopurulent matter; it may affect the bronchioles uniformly (cylindric bronchiectasis), occur in irregular pockets (saccular bronchiectasis) or dilated bronchi may have terminal bulbous [medical-dictionary.thefreedictionary.com]

  Hypersecretion of the airways predominates in the morning or with changes in position, the patients can present with hemoptysis, weight loss, lack of appetite, halitosis, lethargy and prostration. [doi.org]

  Halitosis and abnormal breath sounds, including crackles, rhonchi, and wheezing, are typical physical examination findings. Digital clubbing is uncommon but may be present. [merckmanuals.com]

His workup revealed non-classic cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis (ABPA). [ncbi.nlm.nih.gov]

[…] on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production (see Clinical), and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation (see Workup [emedicine.medscape.com]

• X-Ray Abnormal

  Chest x-ray is usually abnormal and may be diagnostic. [merckmanuals.com]

The major goals of therapy in dealing with bronchiectasis are as follows [9]:

• Improvement of symptoms
• Reduction of complications
• Control of exacerbations
• Reduction of morbidity and mortality

Early recognition is very important when dealing with bronchiectasis and other related conditions. Also, the management of underlying conditions is very important in the overall treatment of the condition. This may include the use of intravenous immunoglobulin or intravenous alpha1-antitrypsin (AAT) therapy.

Antibiotics as well as chest physiotherapy are very important parts of modalities. Other modalities are:

• Bronchodilators
• Corticosteroid therapy
• Dietary supplementation
• Oxygen or surgical therapies

Patients with severe exacerbations of this condition can be treated on admission with a combination of these therapies.

Given the difficulty in identifying prevalence and the lack of definitive studies, it is fairly difficult to estimate current mortality [6]. Generally though, prognosis for patients with bronchiectasis is good. However, it varies based on the type of underlying or predisposing condition. Bronchiectasis associated with cystic fibrosis has the worst form of prognosis.

There are many etiologic factors for bronchiectasis. Some of them are [3]:

• Pulmonary infection
• Aspergillosis 
• Alpha-1 antitrypsin deficiency 
• Aspiration
• Autoimmune disease
• Bronchial obstruction
• Congenital anatomic defect
• Cystic fibrosis
• Malignancy
• Idiopathic inflammatory disorder
• Immunodeficiency 
• Primary ciliary dyskinesia
• Young syndrome
• Cigarette smoking
• Toxic gas exposure

The documentation for this condition is poor around the world so it makes it difficult to have definitive figures for the incidence [4]. However, it is estimated that the condition affects 1 in 100,000 people.

There is no racial or sexual predilection as well.

Bronchiectasis refers to an abnormal dilation of the proximal and medium-sized bronchi [5]. It is often caused by the weakening or destruction of the muscular and elastic components of the bronchial walls. Affected areas may also show a variety of changes which may include transmural inflammation, edema, scarring as well as ulceration. The distal lung parenchyma is also prone to damage following persistent microbial infection or frequent postobstructive pneumonia. Bronchiectasis may be congenital but most of the time it is acquired.

Congenital bronchiectasis most of the time affects infants and children. These cases are as a result of developmental arrest of the bronchial tree.

Acquired forms of these is seen in adults or older children and often require an infectious insult, impairment of drainage, airway obstruction as well as a defect in host defence.

The main way to prevent the development of bronchiectasis is to avoid smoking or drop the habit [10]. Individuals struggling with dropping the habit can be put on tobacco cessation programs as soon as possible.

Occupational exposure to chemical fumes and dust is another common cause of development of this condition. People who work with this kind of lung irritant should take precautionary measures to protect themselves such as the use of respiratory protective equipment.

Bronchiectasis is a pulmonary disorder that usually occurs following some type of infection [1]. The condition is rare and results in a permanent distortion of parts of the airways [2]. The disorder is marked by inflamed and easily collapsible airways, obstruction of airflow as well as shortness of breath and an incapability of clearing out secretions within the airways. In some cases hemoptysis can occur while the more severe cases can lead to respiratory failure. The ailment was first recorded in 1819 by Laennec, but over time the prevalence, and treatment of bronchiectasis has changed.

Bronchiectasis is an incurable chronic lung condition where the wall of the airway of your lungs become damaged, losing their ability to clear out mucus. As mucus builds up, bacteria have a favourable environment to grow in and this brings about repetitive lung infections that can bring damage to your airways.

Since the airways are responsible for the delivery of oxygen and expelling of mucus, this condition has serious consequences most of the time. Heart failure, abscess in the brain or even a collapsed lung are some examples of the consequences.

1. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Does failed chronic wet cough response to antibiotics predict bronchiectasis?. Arch Dis Child. Feb 12 2014.
2. Tiddens HA. Chest computed tomography scans should be considered as a routine investigation in cystic fibrosis. Paediatr Respir Rev. Sep 2006;7(3):202-8. 
3. Young K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiol. Nov 1991;32(6):439-41.
4. Smith IE, Flower CD. Review article: imaging in bronchiectasis. Br J Radiol. Jul 1996;69(823):589-93.
5. Chalmers JD, McHugh BJ, Docherty C, Govan JR, Hill AT. Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis. Thorax. Jan 2013;68(1):39-47. 
6. Barker AF. Bronchiectasis. N Engl J Med 2002; 346:1383.
7. Weycker, D, Edelsberg, J, Oster, G, Tino, G. Prevalence and economic burden of bronchiectasis [obstructive airways disease]. Clin Pulm Med 2005; 12:205.
8. Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142:432.
9. Loukides S, Bouros D, Papatheodorou G, et al. Exhaled H(2)O(2) in steady-state bronchiectasis: relationship with cellular composition in induced sputum, spirometry, and extent and severity of disease. Chest 2002; 121:81.
10. Silva JR, Jones JA, Cole PJ, Poulter LW. The immunological component of the cellular inflammatory infiltrate in bronchiectasis. Thorax 1989; 44:668.