Bronchiectasis Flashcards
what is the definition of bronchiectasis?
Bronchiectasis is the permanent dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall. It is often caused as a consequence of recurrent and/or severe infections secondary to an underlying disorder. The majority of patients will present with a chronic cough and sputum production.
what is the epidemiology of bronchiectasis?
older age
what is the aetiology of bronchiectasis?
Pseudomonas aeruginosa infection
Male sex
Advanced age
Higher residual volume (RV)/total lung capacity (TLC) ratio
Increased wall thickness on computed tomography imaging
Low activity level score as judged by St. George’s Respiratory Questionnaire.
Post-infections, immunodeficiency, genetic, aspiration or inhalation injury, connective tissue disorder, IBD, COPD and asthma, focal bronchial obstruction
what are the risk factors for bronchiectasis?
CF Host immunodeficiency Previous infections Congenital disorders of bronchial airways Primary ciliary dyskinesia
what is the pathophysiology of bronchiectasis?
The dilation and thickening of the bronchi seen in bronchiectasis are due to chronic inflammation elicited by the host response to microorganisms colonising the airways. This persistent airway inflammation leads to the subsequent development of bronchial wall oedema and increased mucus production. Several inflammatory cells including neutrophils, T lymphocytes, and other immune effector cells are recruited to the airways and subsequently release inflammatory cytokines, proteases, and reactive oxygen mediators implicated in the progressive destruction of the airways
what are the key presentations of bronchiectasis?
Patients often present with recurrent pulmonary infections, including a chronic daily productive cough with mucopurulent sputum production.
Crackles and high pitched inspiratory squeaks and rhonchi
Breathlessness
Fever
clubbing
what are the first line and gold standard investigations for bronchiectasis?
A sputum sample should be obtained when the patient is in a stable state and during acute exacerbations.
CXR - may be normal or show obscured hemidiaphragm, thin-walled ring shadows with or without fluid levels, tram lines, tubular or ovoid opacities
CT - thickened, dilated airways with or without air fluid levels; varicose constrictions along airways; cysts and/or tree-in-bud pattern
FBC - WBC differential may reveal high eosinophil count in bronchopulmonary aspergillosis; neutrophilia suggests superimposed infection or exacerbation
high resolution computerised tomography - Bronchial wall dilation
Lack of bronchial tapering
what are the differential diagnoses for bronchiectasis?
COPD
Asthma
Pneumonia
Chronic sinusitis
how is bronchiectasis managed?
Systemic antibiotics directed towards prior culture results should be administered.
Daily airway clearance
Lung transplants
how is bronchiectasis monitored?
Although chest computed tomography scan is the diagnostic procedure of choice, chest x-ray (posteroanterior and lateral) is sufficient for subsequent monitoring.
what are the complications of bronchiectasis?
Massive haemoptysis
Respiratory failure
Cor pulmonale
Ischaemic stroke
what is the prognosis of bronchiectasis?
Bronchiectasis is an irreversible condition. The typical disease course consists of periods of symptom control interrupted by periods of exacerbations.
what is the most common cause of bronchiectasis exacerbation?
haemophilus influenza
what are the key features of kartagener’s syndrome?
bronchiectasis, infertility and situs inversus
