PBL: Bronchiectasis Flashcards
RF for bronchiectasis
- Chronic smoking: chronic bronchitis (mucous production), COPD
- TB
- Autoimmune: RA, CVID
- Congenital: cystic fibrosis (CFTR gene mutation)
Typical presentation of bronchiectasis?
- Chronic mucopurulent cough with haemoptysis presentation, finger clubbing (chronic suppurative disease/hypoxemia), thin (catabolic state)
Mx of haemptysis
* IV fluids, IV antibiotics (infective exacerbation of broncheictasis) transaminic acid, bronchial artery embolization
May have bronchoarterial hypertrophy = destruction of bronchopulmonary bundle
Non resp conditions in bronchiectasis?
- GERD: irritant especially at night due to impaired consiousness causing silent aspiration
- Nose: chronic sinusitis (ciliary problem in kartagener –> chronic rhinosinusitis –> runny nose presentation –> post nasal drip (irritant and cause cough –> can cause aspiration)
Common bacteria in bronchiectasis?
- Pseudomonas aeruginosa, klebsiella pneumonia (associated with DM), e.coli (aspiration pneumonia)
Others non specific infection: H.influenzae, M. catarrhalis, strept pneumoniae.
What mycobacterial disease association with bronchiectasis?
- MTB
- Non tuberculous mycobacterium: M.marinuum, M.abscessus, M.leprae, M. fortuitum (haemoptysis), M. kanasii
- If AFP culture and smear +ve. Ask history of NTM( Bound to collect sample of NTM which grow faster thena MTB) and look at specimen date
What is lung function test for bronchiectasis?
- Normal
- Obstructive pattern: disease itself causing airflow obstruction (results in mucous retention)
- Mixed pattern
What immunomodulatory option is there for bronchiectasis?
Macrolides
* Half the dosage of treatment dosage taken 3 times a week done for around a year for efficacy. Can be done indefinitely if there is decreased exacerbation (can go on drug holiday: no strict guideline for timespan)
* Comparison to macrolides for treatment which is everyday for 1 week
What is used for mx if more than 3x exacerbation of bronchiectasis?
Inhaled gentamicin/tobromycin (aminoglycosides) for pseudomonas aeruginosa infection
* Toxicity of aminoglycosides: nephrotoxicty, ototoxicity, vestibular toxicity
* Inhaled antibiotics used for cystic fibrosis
* With chronic colonization of pseudomonas –> aim for bacteriostatic status
* Nebulized twice daily for 2-4 week cycles –> than off for stabilization of 2-4 weeks
Preemptive IV antibiotics to reduce exacerbation: routinely come back every couple of months
Non pharmacological mx of repeated exacerbation of bronchiectasis?
Sputum clearance
* Better cough techniques
* Physical resonance
* Chest percussion (cupped hand): degree of resonance on the chest wall
Postural drainage