Bronchiectasis Flashcards
What is bronchiectasis?
Irreversible and abnormal dilation of the bronchial tree, often resulting from inflammation, mucus plugging, and progressive airway damage
Which bacterial species are commonly associated with bronchiectasis exacerbations and chronic infection?
Haemophilus influenzae and Pseudomonas aeruginosa.
What are some underlying causes or risk factors for bronchiectasis?
Cystic fibrosis
Chronic obstructive pulmonary disease (COPD)
Lung infections
Aspiration
Tumours
Immunodeficiency
How does excessive inflammation contribute to the development of bronchiectasis?
Airway fibrosis
Dilation
Mucus stasis
Chronic bacterial infection
What are the primary symptoms that patients with bronchiectasis commonly experience?
Chronic productive cough
A large volume of sputum production Fever
Malaise
Occasional hemoptysis
What clinical signs might be observed in a patient with bronchiectasis?
Digital clubbing
Recurrent respiratory infections
Coarse crackles on auscultation
Diminished breath sounds in affected areas
Which diagnostic tests are typically employed to confirm the diagnosis of bronchiectasis?
High-resolution CT (HRCT) scan
Antibody tests (IgG, IgM, IgA)
Microbiological cultures.
What tool is utilized to assess the severity and prognosis of bronchiectasis?
The Bronchiectasis Severity Index (BSI).
How is bronchiectasis typically managed?
Smoking cessation
Vaccination
Airway clearance techniques
Antibiotic therapy
Anti-inflammatory agents.
What are some characteristic imaging findings of bronchiectasis on a high-resolution CT (HRCT) scan?
Thickened and dilated airways with characteristic “tram-line shadowing”
How does the microbiome in bronchiectasis patients typically differ from healthy individuals?
Dominated by infectious bacteria, which constitute 90-95% of the microbiome
A 19 year old male presents to the Emergency Department with fever and a cough with productive, purulent sputum. This is his fourth infection in seven months, the others being otitis media, sinusitis and pneumonia. On examination, you notice that he is clubbed. Percussion is dull at the left base during expiration and resonant on inspiration. His Chest Xray shows evidence of dextrocardia. There are bilateral coarse crepitations and a chest CT shows thickened, dilated bronchi. What is the most likely overarching diagnosis?
Primary ciliary dyskinesia
A 42-year-old female with a history of cystic fibrosis and resultant bronchiectasis presents to their GP with a 4-day history of increased sputum production and change in sputum colour. They are usually managed with daily chest physiotherapy and at-home nebulisers (bronchodilators and saline) to aid sputum expectoration. A sputum culture is performed which confirms infection with Pseudomonas aeruginosa which is treated fully. This is the patient’s third confirmed Pseudomonas infection in the past year.
What is the next most appropriate treatment to initiate in this patient?
Long term prophylactic antibiotics
When would Intravenous (IV) antibiotics be prescribed over a 14-day course of oral ciprofloxacin 500mg twice daily?
Clinical features that are worrying with a high fever and high respiratory rate
A 55-year-old woman presents to the GP practice with a history of a persistent cough, productive of yellow sputum that is sometimes blood-tinged.
On examination, she has finger clubbing and coarse inspiratory crepitations on auscultation.
Which is the most appropriate treatment to initiate?
Chest physiotherapy
