Bronchiectasis Flashcards
(9 cards)
Definition
Bronchiectasis is permanent dilation of the bronchi and bronchioles due to chronic infection.
What main organisms cause this infection?
The main organisms patients are infected by include:
Haemophilius Influenzae
Pseudomonas aeruginosa
Streptococcus Pneumoniae
Staphylococcus aureus.
Causes
Post-Infection: Tuberculosis; HIV; Measles; Pertussis; Pneumonia
Bronchial Pathology: Obstruction by foreign body or tumour
Allergic Bronchopulmonary aspergillosis (ABPA)
Congenital: Cystic fibrosis; Kartagener’s syndrome; Primary ciliary dyskinesia; Young syndrome
Hypogammaglobulinaemia
Idiopathic
Presentation
Symptoms
Productive Cough
Large amounts of purulent sputum
Haemoptysis
Signs
Finger clubbing
Coarse inspiratory crepitations
Dyspneoa
Wheeze
Investigations
Spirometry: bronchiectasis has an obstructive pattern of disease. Additionally, it allows clinicians to assess the reversibility of the disease and severity
Sputum culture: to identify pathogens and guide management with antibiotics.
Chest X-ray: thickened bronchial walls, and cystic appearance, otherwise known as tramline and ring shadows
High-resolution CT: This is the best diagnostic investigation of bronchiectasis. It is monitoring the severity of the condition and can guide management.
Bronchoscopy: This allows clinicians to locate areas of obstruction, haemoptysis or sample tissue for culture.
Other investigations for cause
Serum immunoglobulins – Hypogammaglobulinaemia
Cystic fibrosis sweat test – Cystic Fibrosis
Aspergillus precipitins or skin prick test – ABPA
Rheumatoid Factor or ANA – rheumatoid arthritis
Conservative Management
Patient Education
Support Group
Chest Physiotherapy – Postural drainage at least twice daily to aid mucous drainage
Smoking Cessation
Medical Management
Antibiotics – according to local guidelines, and bacterial sensitivities. Patient with recurrent exacerbations may require long term antibiotic treatment
Bronchodilators – Including salbutamol can be given to patients with symptoms of dyspneoa and wheeze such as COPD, ABPA, asthma
Corticosteroid - Prednisolone is used in ABPA treatment
Carbocysteine - Mucolytic which reduces the viscosity of sputum
Surgical Management
Surgical excision of localized area of disease or cessation of haemoptysis.
Lung transplant may be indicated in certain patients