Bronchiectasis Flashcards

1
Q

Define bronchiectasis

A

Chronic dilation of the bronchi due to destruction of the elastic and muscular components of the bronchial wall, leading to impaired mucocilliary clearance and frequent bacterial infections

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2
Q

What is the aetiology for bronchiectasis

A

Severe inflammation → fibrosis and dilation of bronchi → pooling of mucous → infection → damage and fibrosis to bronchial walls

Post-infectious (30%) - commonly post-LRTI
Viral: measles, influenza, whooping cough
Mycobacteria or pneumonia: H. influenzae, pseudomonas
Fungal: aspergillus fumigatus
Swyer-james or Macleod’s syndrome
Immunodeficiency: Ig deficiency, HIV infection
Genetic: Cystic fibrosis
Ciliary dyskinesia ± Kartagener’s syndrome
aspiration or inhalation injury
Alpha-1 antitrypsin deficiency
Connective tissue disorders e.g. RA, Sjrogen’s
IBD
COPD and asthma
Idiopathic
Focal bronchial obstruction e.g. Foreign body, broncholith, stenosis, tumour, adenopathy

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3
Q

What is Macleod’s syndrome

A

chronic manifestation of bronchiolitis or pneumonitis in childhood, characterised by unilateral pulmonary hypoplasia and radiographic hyperlucency

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4
Q

What is Kartagener’s syndrome

A

autosomal-recessive condition, triad of:
1. Ciliary dyskinesia
2. Situs inversus
3. Chronic sinusitis

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5
Q

What are the symptoms of bronchiectasis

A

Productive cough:
- Purulent sputum, daily large volume
- >6 weeks
- ± haemoptysis
- Chronic or moist cough unresponsive to 4wks of Abx
Breathlessness, dyspnoea (on exertion)
Chest pain between exacerbations
Malaise
Fever
Weight loss
Rhinosinusitis

*Symptoms often begin after an acute respiratory illness

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6
Q

What are the differentials for bronchiectasis

A

Asthma
COPD
Chronic sinusitis
Pneumonia
Lung cancer
Interstitial lung disease
Hypersensitivity pneumonitis
Pulmonary fibrosis
Sarcoidosis
TB

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7
Q

What are the signs of bronchiectasis on examination

A

Obs: ?sats
Weight and height
Respiratory:
- Clubbing
- Chest deformity and hyperinflation
- Coarse crepitations (usually at the base) that may shift with coughing
- Wheeze or high-pitch inspiratory squeaks
- Large airway rhonchi (low pitched snore-like sounds)
- Palpable chest secretions on coughing

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8
Q

What investigations should be done for bronchiectasis

A

Bedside: Sputum MC&S
Bloods: FBC, CRP, ESR, Blood gas, blood cultures, Alpha-1 antitrypsin level, serum Ig, HIV serology
Other:
- CXR: dilated bronchi (parallel lines radiating from hilum to diaphragm/Tramline shadow), fibrosis, atelectasis, pneumonic consolidation, ring shadows, volume loss, air-fluid levels
- High resolution CT (HRCT): Signet ring sign, dilated bronchi with thickened walls
- Spirometry: reduced FEV1, elevated RV/TLC
± sweat chloride test
± rheumatoid factor, anti-CCP

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9
Q

What is the management for chronic bronchiectasis

A

Refer to respiratory consultant

Lifestyle: Exercise + improved nutrition
Airway clearing:
- Airway clearance therapy
- Chest physiotherapy
- High frequency oscillation devices
- Inhaled bronchodilator, nebulised hypertonic saline
- Mucoactive agent e.g. carbocysteine
Infection prevention:
Frequent (>3/year) exacerbations → Prophylactic antibiotic courses (oral or aerosolised) - Azithromycin for 6 months*
Consider flu vaccination

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10
Q

What is the management for acute exacerbations of bronchiectasis

A

First line: 2x IV Abx (should cover for pseudomonas)
- amoxicillin/clarithromycin/doxycycline
- If pseudomonas +ve: Colistin
Bronchodilator e.g. salbutamol
Airway clearance therapy: hydration, postural drainage, percussion, vibration and oscillatory device usage
Physiotherapy, exercise and improved nutrition
Asthma/COPD: Inhaled corticosteroid e.g. fluticasone

Life threatening haemoptysis → Bronchial artery embolisation*
Severe: localised resection, lung or heart-lung transplant

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11
Q

What features necessitate for admission for bronchiectasis

A

Significant comorbidities
Cyanosis.
Confusion.
Marked breathlessness, rapid respiration, or laboured breathing.
Peripheral oedema.
Have a temperature of 38°C or higher.

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12
Q

What are the complications of bronchiectasis

A

Haemoptysis → life threatening
Persistent infection
Empyema
Pneumothorax
respiratory failure
Cor Pulmonale
Anxiety and depression
Urinary incontinence
Fatigue and reduced exercise intolerance
Nutritional deficiency → growth retardation

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13
Q

What is the prognosis for bronchiectasis

A

People with mild bronchiectasis can have a normal life expectancy
Approx. 50% of people will have 2 exacerbations a year, with 1/3 requiring hospitalisation

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