PBL: Bronchiectasis Flashcards

1
Q

RF for bronchiectasis

A
  • Chronic smoking: chronic bronchitis (mucous production), COPD
  • TB
  • Autoimmune: RA, CVID
  • Congenital: cystic fibrosis (CFTR gene mutation)
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1
Q

Typical presentation of bronchiectasis?

A
  • 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

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2
Q

Non resp conditions in bronchiectasis?

A
  • 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)
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3
Q

Common bacteria in bronchiectasis?

A
  • Pseudomonas aeruginosa, klebsiella pneumonia (associated with DM), e.coli (aspiration pneumonia)

Others non specific infection: H.influenzae, M. catarrhalis, strept pneumoniae.

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4
Q

What mycobacterial disease association with bronchiectasis?

A
  • 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
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5
Q

What is lung function test for bronchiectasis?

A
  • Normal
  • Obstructive pattern: disease itself causing airflow obstruction (results in mucous retention)
  • Mixed pattern
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6
Q

What immunomodulatory option is there for bronchiectasis?

A

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

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7
Q

What is used for mx if more than 3x exacerbation of bronchiectasis?

A

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

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8
Q

Non pharmacological mx of repeated exacerbation of bronchiectasis?

A

Sputum clearance
* Better cough techniques
* Physical resonance
* Chest percussion (cupped hand): degree of resonance on the chest wall

Postural drainage

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