8.6 Pathophysiology, Diagnosis & Treatment of Bronchiectasis Flashcards
(42 cards)
Describe the history findings of bronchiectasis
- Productive cough
- Chronic/recurrent episodes [>3] each leasting >4 weeks
- Could have dyspnoea wheeze, growth failure etc.
Aside from its clinical syndrome, what else is needed to diagnose bronchiectasis? If this is not present, what is the new diagnosis?
Needs radiographic features of HRCT
With: bronchiectasis
Without: Chronic suppurative lung disease
What is meant by a suppurative cough
A cough where purulent sputum (i.e. sputum containing pus) is produced
What is the pathological description of bronchiectasis?
Permanent and abnormal dilation of the bronchi; usually in the context of chronic airway infection causing inflammation
HRCT diagnostic features of bronchiectasis
- Diameter of bronchi wider than pulmonary arteries
- Failure of bronchi to taper, causing:
- Visualisation of bronchi in outer 1-2cm of the lung fields
Describe the ‘cycle of bronchiectasis’, starting from inflammation
- Inflammation
- Abnormal airway function
- Infection
- Thickened airway secretions
What innate immune cells are primarily involved in the inflammatory response during bronchiectasis
Neutrophils
Describe the pathophysiology of bronchiectasis
- Impaired drainage, airway obstruction, or a defect in host defense
- Immune effector cells and inflammatory cytokines activated
- Transmural inflammation, mucosal oedema, ulceration in airways
Abnormal airway function can start the cycle of bronchiectasis. What are some ways that this can occur?
- Cystic fibrosis
- Ciliary dyskinesia
Infection can start the cycle of bronchiectasis. What are some ways that this can occur?
Recurrent pneumonia;
- Post-obstruction (e.g. inhaled foreign body)
- Post infection (tuberculosis, adenovirus)
Thickened airway secretions can start the cycle of bronchiectasis. What is one way this can occur?
- Young syndrome (thick production of mucus)
Inflammation can start the cycle of bronchiectasis. What are some ways that this can occur?
- Systemic inflammatory disease (e.g. sarcoidosis)
- Recurrent small volume aspiration (e.g. gastric contents)
- Chronic infection (e.g. TB)
List some common respiratory diseases that can be comorbid with bronchiectasis
- COPD
- Pulmonary fibrosis
- Pneumoconiosis
Is bronchiectasis more common in men or women?
Women
After the age of 60, by what factor does the risk of bronchiectasis increase?
8 to 10
Sputum-related questions to ask during a history
- Volume
- Nature
- Colour
- Frequency
History symptoms indicative of bronchiectasis
- Sputum/haemoptysis
- Dyspnoea/exercise intolerance
- Impaired sleep quality
- Systemic infection (fever/sweats/fatigue)
- Poor appetite/underweight
Vaccines that are important for reducing risk/worsening of bronchiectasis
- Flu
- Pneumococcus
- COVID
Focused history questions for cystic fibrosis
- Family history
- Pancreatitis
- Difficulty maintaining weight (not so much any more)
- Male infertility
Focused history questions for underlying immune deficiency/ciliary dyskinesia
- Recurrent sinusitis
- Extrapulmonary infections (discharging ears/severe dermatitis)
- Male infertility
Focused history questions to ask for recurrent aspiration
- Cough and or choking when eating?
- Cough when laying down/during the night?
List some respiratory comorbidities of bronchiectasis
- COPD
- Asthma
- Pulmonary fibrosis
- MSK issues
How can MSK issues cause bronchiectasis?
- Inability to cough
- Reduced ability to clear irritants/pathogens
- Starts bronchiectasis cycle
How can pulmonary fibrosis cause bronchiectasis?
- Fibrotic tissue
- Creates traction bronchiectasis
- Leads to abnormal airways, and therefore starts the bronchiectasis cycle
