Bronchiectasis Flashcards
What is bronchiectasis characterised by?
Permanent bronchial dilation dues to irreversible damage to the bronchial wall
What mechanism causes bronchiectasis?
• There is an initial insult to the bronchi (e.g. an infection) which leads to an immune response and subsequent inflammation
• This inflammation damages the muscle and elastin in the bronchi → bronchial dilation which is not reversed in those with bronchiectasis
What are the 5 main groups of causes of bronchiectasis?
Post infectious e.g. childhood (influenza, pertussis, measles), pulmonary tb
Pulmonary disease e.g. COPD, asthma
Congenital e.g. cystic fibrosis, alpha 1 antitrypsin deficiency
Connective tissue disorders e.g. RA, SLE, sarcoidosis
Idiopathic
What are the risk factors of bronchiectasis? (3)
• >70 years old
• Female
• Smoking history
What are the symptoms of bronchiectasis? (5)
• Daily cough - producing copious sputum (haemoptysis present in 50%)
• Exertional dyspnoea
• Fatigue
• Rhinosinusitis symptoms e.g. nasal discharge, nasal obstruction, facial pressure
• Weight loss
What are the clinical signs of bronchiectasis? (7)
• History of childhood LRTI
• Smoking history
• Finger clubbing
• Course crepitations present in expiration and inspiration
• Rhonchi (low-pitched noises that sound like snoring) caused by movement of secretions
• High pitched inspiratory squeaks and pops
• Wheeze
What is the conservative management of bronchiectasis? (3)
• Pulmonary rehabilitation, physio will teach them airway clearance techniques
• Smoking cessation
• Annual influenza and one-off pneumococcal vaccine
What are the medical managements of bronchiectasis? (5)
• Mucoactive agents e.g. nebulised hypertonic saline (7%), carbocisteine to aid in clearance of sputum
• Prophylactic antibiotics e.g. azithromycin 3x a week
• Bronchodilators if the dyspnoea is activity-limiting
• Specific treatment for causes
• LTOT if sats on room air are <80%
What are the surgical managements of bronchiectasis? (2)
• Lung resection if bronchiectasis is localised
• Lung transplant if patient is <65yo and are rapidly declining despite optimum medical management
What common organisms are found in bronchiectasis? (2)
○ Pseudomonas aeruginosa
○ Haemophilus influenza
What is seen on Spirometry in bronchiectasis?
Obstructive pattern
What is the gold standard investigation for bronchiectasis?
High resolution ct chest
What is seen on a high resolution ct chest in bronchiectasis?
• Shows bronchial dilation, with or without airway thickening
• Bronchiole is bigger or same size as adjacent blood vessel
What are some complications of bronchiectasis? (5)
• Respiratory failure due to failed gas exchange in the lungs
• Massive haemoptysis due to rupture of a bronchial artery into a bronchus
• Anxiety and depression due to impaired quality of life
• Infective exacerbations
• Cor pulmonale
