From the Guidelines
Bilateral upper lobe bronchiectasis is most commonly caused by cystic fibrosis, allergic bronchopulmonary aspergillosis (ABPA), and primary ciliary dyskinesia, which can lead to significant morbidity and mortality if left untreated or poorly managed 1.
Causes of Bilateral Upper Lobe Bronchiectasis
The causes of bilateral upper lobe bronchiectasis can be attributed to various underlying conditions, including:
- Cystic fibrosis, a genetic disorder affecting chloride channels, leading to thick mucus production that damages airways over time
- Allergic bronchopulmonary aspergillosis (ABPA), an allergic reaction to Aspergillus fungi, causing inflammation and airway damage primarily in the upper lobes
- Primary ciliary dyskinesia, involving dysfunctional cilia that cannot clear secretions effectively Less common causes include tuberculosis, sarcoidosis, and alpha-1 antitrypsin deficiency.
Diagnosis and Treatment
Diagnosis typically requires high-resolution CT scanning to confirm bronchiectasis and specific testing for underlying causes, including genetic testing for cystic fibrosis, serum IgE and Aspergillus antibodies for ABPA, and ciliary function tests for primary ciliary dyskinesia 1. Treatment focuses on addressing the underlying cause while managing symptoms through airway clearance techniques, antibiotics for infections, and bronchodilators as needed. It is essential to investigate the underlying cause of bronchiectasis, as it can change patient management and identify previously unrecognised conditions, ultimately improving quality of life and reducing morbidity and mortality 1.
From the Research
Causes of Bilateral Upper Lobe Bronchiectasis
- Cystic fibrosis 2
- Allergic bronchopulmonary aspergillosis 2
- Traction bronchiectasis caused by prior tuberculosis 2, 3
- Traction bronchiectasis caused by sarcoidosis 2
- Traction bronchiectasis caused by silicosis with progressive massive fibrosis 2
- Post-TB bronchiectasis 3
- Nontuberculous mycobacterial pulmonary infection 4
- Marfan's syndrome 5