Bronchiectasis Flashcards
What is bronchiectasis?
Abnormal dilation of bronchi due to destruction of elastic/muscular components of bronchial wall - often consequence of recurrent/severe infections secondary to an underlying disorder, majority present with chronic cough + sputum production
When does bronchiectasis mainly occur?
Initially in childhood, incidence has decreased with antibiotic use
Describe the aetiology of bronchiectasis
- Chronic lung inflammation leads to fibrosis and permanent dilation of the bronchi
- Pooling of mucus - predisposes to further cycles of infection, damage and fibrosis of bronchial walls
- Inflammation leads to bronchial wall oedema and more mucus production
- Inflammatory cells recruited to airway releasing cytokines, proteases and reactive oxygen mediators implicated in the progressive destruction of airways.
What are causes of bronchiectasis?
- Idiopathic - 50%
- Post infectious - H. influenzae, S. pneumoniae, S. aureus, P. aeruginosa
- Congenital - CF, A1AD, Ciliary dyskinetic syndromes (Kartagener’s)
- Obstruction of bronchi - foreign body, enlarged lymph nodes, tumour
What are symptoms of bronchiectasis?
- Productive cough with purulent sputum and ocassional haemoptysis
- Paroxysms of cough in morning
- Breathlessness/dyspnoea
- Chest pain
- Malaise
- Fever
- Weight loss
- Usually begin after an acute respiratory illness
What are signs
- Early inspiratory coarse crackles and squeaks - crepitations at lung bases which shift with coughing
- Wheeze
- Clubbing
What investigations are carried out for bronchiectasis?
- High resolution CT - gold standard
Shows dilated bronchi with thickened walls, tram tracks and signet ring sign - FBC - WBC identifies superimposed infection and eosinophilia can suggest allergic bronchopulmonary aspergillus
- Sputum - most common organism is H. influenzae
- Test for underlying causative condition
What is maintenance therapy for bronchiectasis?
- Conservative
- Airway clearance - oral hydration, chest physiotherapy (postural drainage), nebulised hyperosmolar agents like hypertonic saline/mannitol
- Inhaled bronchodilators - salbutamol/ipratropium
- If frequent exacerbations, prophylactic antibiotics like long-term macrolides like erythromycin
How does an exacerbation present and how is it managed?
Presents with change in sputum colour, increase in volume, worsening cough, fever and malaise
Outpatient care - 14 day oral antibiotics (amox/clarith/trimeth)
If pseudomonas/severe infection - IV aminoglycoside/fluoroquinolone for 14 days minimum
What are other management options for bronchiectasis?
Annual flu vaccine
Bronchial artery embolisation - if life-threatening haemoptysis
Surgical - localised resection, lung/heart transplant
When is a lung transplant considered for a bronchiectasis patient?
If FEV <30%, recurrent refractory pneumothorax or haemoptysis not controlled by embolisation
What are possible complications?
- Life threatening haemoptysis
- Persistent infection
- Empyema
- Resp failure
- Cor pulmonale - pulmonary hypertension
- Multi-organ abscesses
