Bronchiectasis Flashcards
Define Bronchiectasis
Chronic dilatation of airways leading to chronic infection/inflammation
What are the causes of Bronchiectasis?
IDIOPATHIC
Post infective - TB, measles, pertussis, pneumonia
CF
Bronchial obstruction - Tumour, FB
Allergic broncho-pulmonary aspergillosis
Ciliary dyskinetic syndromes - Kartagener’s, Young’s
Immune deficiency - IgA, hypoammaglobulinaemia
Connective tissue diseases - RA
What are the symptoms of Bronchiectasis?
Recurrent cough Copious purulent sputum Intermittent haemoptysis (can be only sx) Persistent halitosis Dyspnoea Recurrent febrile episodes/pneumonia
What are the signs of Bronchiectasis?
Clubbing
Coarse insp crepitations
Wheeze
Low body habitus (high energy demands)
What are the complications of Bronchiectasis?
Pneumonia Pneumothorax Empyema Lung abscess Haematogenous spread of infection Life-threatening haemoptysis
What are the investigations used to confirm a diagnosis of Bronchiectasis?
Sputum culture CXR (cystic shadowing) HRCT (assess distribution) Spirometry Bronchoscopy
What signs of Bronchiectasis are present on a CXR?
Cystic shadows
Thickened bronchial walls
What does Spirometry reveal about Bronchiectasis?
Obstructive pattern
Reversibility can be assessed
What does Bronchoscopy reveal about Bronchiectasis?
Locates sites of haemoptysis
Exclude obstruction
How can Bronchiectasis and COPD be distinguished?
Infections vs Smoking
Productive vs Dry cough
Insp creps AND wheeze
What is the underlying pathology of Bronchiectasis?
Bronchi at lung bases most commonly involved
Dilated airways, purulent secretions, chronic inflammation
Granulation tissue bleeds lead to haemoptysis
Fibrous scarring if repeated exacerbations
How should Bronchiectasis be managed?
Assess for rare/treatable causes Smoking cessation Physiotherapy & postural drainage A/b for exacerbations Immunisations Bronchodilators Surgery rarely indicated
What are the most common infective organisms in Bronchiectasis?
Haemophilus influenzae
Pseudomonas
Klebseilla
Strep pneumoniae
