Bronchiecstasis

Question 1

BRONCHIECTASIS

Answer 1

• Abnormal and permanently dilated airways; Bronchial walls are inflamed, thickened and irreversibly damaged, Mucociliary transport impaired and frequent infections occur
• Productive cough with large amounts of discoloured sputum; Dilated, thick bronchi on CT
• Most commonly caused by Cystic Fibrosis in developed countries; Can also be due to
mechanical obstruction (e.g. Tumour, Foreign body), Pneumonia, Granuloma, Diffuse
Diseases of Lung Parenchyma, Immune overresponse and defects
• Most patients with severe disease develop Respiratory Failure, Cor Pulmonale

Question 2

Presentation of Bronchiectasis

Answer 2

• Produce yellow or green sputum after infection; Persistent halitosis, recurrent Febrile
episodes with Malaise and Pneumonia; SOB may occur from airflow limitation
• Clubbing, Coarse Crackles over affected areas (usually bases)
• Severe Bronchiectasis – Continuous production of foul-smelling, thick, khaki coloured sputum
• Haemoptysis can be massive haemorrhage; Due to high
pressure systemic Bronchial Arteries, mortality 25%;
Urgent Bronchoscopy, treatment by embolisation,
surgical resection if that fails
o DDX Haemorrhage; TB, Aspergilloma, Lung
Abscess and Malignant tumours

Question 3

Investigations for Bronchiectasis

Answer 3

• CXR – Dilated Bronchi with thickened walls, may have
multiple cysts containing fluid; But CXR may be normal
• HRCT – Thickened dilated Bronchi and cysts at ends of
Bronchioles; Airways are characteristically larger than
associated blood vessels
• Sputum Culture – S aureus, P aeruginosa, H influenzae
and Anaerobes; S pneumoniae and K pneumoniae
might also be present; Aspergillus fumigatus in 10%,
MAI increasingly found
• Sinus XR – 30% of patients have Rhinosinusitis
• Serum Ig – 10% of adults with Bronchiectasis antibody
or subclass deficient (IgA especially); Response to Hib
and Pneumococcal vaccines may be impaired
• Mucociliary Clearance – Test by 1mm cube of saccharin and time to taste measured

Question 4

Treatment of Bronchiectasis

Answer 4

• Postural Drainage – Part of Pulmonary Rehabilitation; Tip themselves so affected lobes are
uppermost at least 3 times a day for 10-20 minutes
• Eradication of Bronchopulmonary Infections to stop progression of disease (e.g. Cefaclor,
Ciprofloxacin; Flucloxacillin if S aureus is isolated; If sputum remains yellow or green despite
physiotherapy and antibiotics, or if Lung Function deteriorates even with Bronchodilators, P
aeruginosa infection likely
• Bronchodilators useful for patients with demonstrable Airflow Limitation; Inhaled or Oral
steroids can decrease rate of progression