Bronchiectasis

Question 1

What type of disease is Bronchiectasis?

Answer 1

Obstructive lung disease

Question 2

What does bronchiectasis result in?

Answer 2

Local irreversible dilation of the bronchial tree.

Question 3

What is bronchiectasis due to?

Answer 3

Destruction of muscle and elastic tissue

Question 4

What is bronchiectasis usually a result of?

Answer 4

Bronchial obstruction leading to infection with inflammation

Question 5

What is the most common cause of bronchiectasis in the UK?

Answer 5

Cystic fibrosis

Question 6

What is the most common cause of bronchiectasis worldwide?

Answer 6

TB

Question 7

What are the main symptoms of Bronchiectasis?

Answer 7

Persistent cough
Copious purulent sputum
Intermittent haemoptysis

Question 8

What are the main signs of bronchiectasis?

Answer 8

Finger clubbing
Coarse inspiratory crepitations
Wheeze

Question 9

What chest sounds would be present with bronchiectasis?

Answer 9

Coarse crackles
wheeze

Question 10

What organisms commonly cause bronchiectasis?

Answer 10

• Haemophilius Influenzae
• Pseudomonas aeruginosa
• Streptococcus Pneumoniae
• Staphylococcus aureus

Question 11

What is the most common organism that can be isolated from patients with bronchiectasis?

Answer 11

Haemophilus influenza

Question 12

What are other common causes of Bronchiectasis?

Answer 12

• bronchial obstruction e.g. lung cancer/foreign body
• immune deficiency: hypogammaglobulinaemia
• allergic bronchopulmonary aspergillosis (ABPA)
• ciliary dyskinetic syndromes: Kartagener’s syndrome

Question 13

What immune deficiency can predispose to bronchiectasis?

Answer 13

Hypogammaglobulinemia

Question 14

What ciliary dyskinetic syndrome can predispose to bronchiectasis?

Answer 14

Kartagener’s syndrome
Young’s syndrome)

Question 15

What are the main 3 tests for someone presenting with possible bronchiectasis?

Answer 15

Sputum sample
Chest x-ray
CT chest

Question 16

Why might you do a sputum sample for someone presenting with possible bronchiectasis?

Answer 16

To identify pathogens and guide management with antibiotics.

Question 17

What is the problem with doing a chest x-ray in someone with broncheictasis?

Answer 17

This will be normal, unless the bronchiectasis is widespread/advanced

Question 18

What is the best diagnostic test for bronchiectasis?

Answer 18

CT chest

Question 19

What might you see on a chest x-ray in someone with advanced bronchiectasis?

Answer 19

Areas of thickened bronchial walls and Cystic appearance
(Tramline and ring shadows)

Question 20

What might you see on a CT of someone with bronchiectasis?

Answer 20

Bronchial dilatation
Bronchial wall thickening
Classic signet ring appearance

Question 21

What is the main management for patients that do not have CF?

Answer 21

Physical training (e.g. inspiratory muscle training

Question 22

What else can be done for patients with broncheictasis?

Answer 22

postural drainage
antibiotics for exacerbations
bronchodilators i
immunisations
surgery- Localised disease

Question 23

When might you consider surgery in a patient with bronchiectasis?

Answer 23

If the disease is localised

Question 24

What are possible complications of bronchiectasis?

Answer 24

Abscess
Empyema
Pulmonary fibrosis
Cor pulmonale
Secondary Amyloidosis

Question 25

What are the conservative managements of bronchiectasis?

Answer 25

Patient Education
Support Group
Chest Physiotherapy
Smoking Cessation

Question 26

What does chest phsyiotherapy involve?

Answer 26

Postural drainage at least twice daily to aid mucous drainage

Question 27

What can be used to reduce the viscosity of the sputum?

Answer 27

Mucolytics- Carbocysteine

Question 28

Example of patient

Answer 28

2-year history of cough productive with copious thick yellow sputum and SOB on exertion.
Cough has been intractable
Given multiple courses of antibiotics with no success.

On examination, low-pitched expiratory wheezes and crackles in both lungs and fingernail clubbing is noted. A chest x-ray shows airway thickening.