Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

An acquired irreversible dilation and distortion of the airways that often results when pulmonary infection leads to destruction of bronchial wall cartilage, blood vessels elastic tissue and smooth muscle

Question 1

An acquired irreversible dilation and distortion of the airways describes what?

Answer 1

Bronchiectassis

Question 2

What causes bronchiectasis?

Answer 2

A pulmonary infection that leads to destruction of bronchial wall cartilage, blood vessels, elastic tissue and smooth muscle

Question 3

What portion of the lung is bronchiectasis most likely to affect?

Answer 3

Smaller airways with less supporting cartilage

Question 4

T/F: Bronchiectasis is generally limited to one area of the lung

Answer 4

False, it can be limited to one specific area by it also can involve multiple areas or be diffuse

Question 5

T/F: bronchiectasis is a primary disease process

Answer 5

False. Bronchiectasis develops secondary to another disease process, generally pulmonary infections

Question 6

When diagnosing bronchiectasis, what questions should you be asking?

Answer 6

What other disease processes are active with this
What other disease processes we active that allowed for this in the past

Question 7

What are the 3 patterns of dilation associated with bronchiectasis?

Answer 7

Cylindrical aka tubular
Varicose aka fusiform
Saccular aka cystic

Question 8

Describe varicose bronchiectasis

Answer 8

The bronchi are dilated and constricted in an irregular fashion similar to varicose veins resulting in a distorted bulbous shape
Kind of have a corrugated look to the bronchi

Question 9

Describe cylindrical bronchiectasis

Answer 9

The bronchi are dilated and rigid and have regular outlines like a tube. They will fail to taper for 6-10 generations before appearing to abruptly end because of mucus obstruction

Question 10

Describe cystic/saccular bronchiectasis

Answer 10

The bronchi progressively increase in diameter until they end in large cyst like sacs in the lung parenchyma
Ring opacities can be visible at bases of the lung

Question 11

Describe the effects of bronchiectasis on the lungs

Answer 11

Chronic dilation and distortion of bronchial airways
Excessive production of foul smelling sputum
Bronchospasm
Hyperinflation of alveoli
Atelectasis
Consolidation and parenchymal fibrosis
Hemorrhage secondary to bronchial arterial erosion

Question 12

What is the prevalence of bronchiectasis in the united states

Answer 12

350-500k adults have the disease

Question 13

Who is more likely to be diagnosed with bronchiectasis?

Answer 13

Women
Older than 60

Question 14

Describe how bronchiectasis emerges as a disease process in an individual with a pulmonary infection

Answer 14

An individual has a pulmonary infection or injury to their airway, as a result the body responds with inflammation which damages the airway walls and impairs the mucociliary escalator which compromises secretion clearance and allows for continued infection resulting in a repeat of the cycle

Question 15

What kind of conditions can result in bronchiectasis?

Answer 15

Pulmonary infection
Obstruction
Impairment of normal airway clearance
Impairment of immune response

Question 15

Infections are a key cause of bronchiectasis, what kind of infection history could support a diagnosis of bronchiectasis?

Answer 15

A history of severe pulmonary infections
A history of pulmonary infections as a child
Repeated viral, bacterial or fungal infections of the respiratory system

Question 16

How are COPD and bronchiectasis related?

Answer 16

COPD causes flow restrictions and airway remodeling leading to reduced airway clearance and chronic infections resulting in chronic inflammation responses which can cause bronchiectasis

Question 16

How can mycobacteria lead to bronchiectasis?

Answer 16

Mycobacteria are responsible for tuberculosis which can serve as a catalyst for starting the inflammation cycle that can result in bronchiectasis

Question 16

Describe hypersensitivity bronchiectasis

Answer 16

Infection with aspergillus fumigatus leads to a aspergillus hypersensitivity resulting in repeated inflammatory responses resulting in bronchiectasis

Question 17

How can aspiration lead to bronchiectasis?

Answer 17

Aspirations leading to obstruction via a foreign body can lead to retained secretions and infection
Aspiration of stomach contents can cause chronic inflammation and damage the airway

Question 18

How can tumors or enlarged lymph nodes lead to bronchiectasis?

Answer 18

The can obstruct airways and prevent airway clearance leading to chronic infection and inflammation

Question 19

What immunocompromised states can lead to bronchiectasis?

Answer 19

HIV
Chemotherapy

Question 19

What is necessary for a bronchiectasis diagnosis?

Answer 19

History of appropriate clinical manifestations
A high resolution CT scan

Question 19

What systemic inflammatory disease conditions can lead to bronchiectasis?

Answer 19

Rheumatoid arthritis
Sarcoid
Systemic lupus erythmatosis

Question 20

What clinical manifestations are required to diagnose bronchiectasis?

Answer 20

Cough on most days of the week
Sputum production on most days of the week
History of exacerbations

Question 21

T/F: bronchiectasis can present as an obstructive disorder, a restrictive disorder, or a combination of both

Answer 21

True

Question 21

Describe how airways might appear on a HR CT scan of a patient with bronchiectasis

Answer 21

The internal airway lumen can be wider than the adjacent pulmonary artery diameter
Lack of tapering in the bronchi = tram track appearance
Airway visibility with 1 cm of costal pleural surface or touching the mediastinal pleura

Question 22

What might a patient experience during a bronchiectasis exacerbation?

Answer 22

Changes in cough
Changes in sputum production, volume, or consistency
Changes in breathlessness or exercise tolerance
Fatigue or malaise
Hemoptysis

Question 23

How is bronchiectasis managed?

Answer 23

By treating the underlying comorbidity
Antibiotics, airway clearance aerosolized medications….