Bronchiectasis Flashcards
Define bronchiectasis
Chronic dilation of the bronchi due to destruction of the elastic and muscular components of the bronchial wall, leading to impaired mucocilliary clearance and frequent bacterial infections
What is the aetiology for bronchiectasis
Severe inflammation → fibrosis and dilation of bronchi → pooling of mucous → infection → damage and fibrosis to bronchial walls
Post-infectious (30%) - commonly post-LRTI
Viral: measles, influenza, whooping cough
Mycobacteria or pneumonia: H. influenzae, pseudomonas
Fungal: aspergillus fumigatus
Swyer-james or Macleod’s syndrome
Immunodeficiency: Ig deficiency, HIV infection
Genetic: Cystic fibrosis
Ciliary dyskinesia ± Kartagener’s syndrome
aspiration or inhalation injury
Alpha-1 antitrypsin deficiency
Connective tissue disorders e.g. RA, Sjrogen’s
IBD
COPD and asthma
Idiopathic
Focal bronchial obstruction e.g. Foreign body, broncholith, stenosis, tumour, adenopathy
What is Macleod’s syndrome
chronic manifestation of bronchiolitis or pneumonitis in childhood, characterised by unilateral pulmonary hypoplasia and radiographic hyperlucency
What is Kartagener’s syndrome
autosomal-recessive condition, triad of:
1. Ciliary dyskinesia
2. Situs inversus
3. Chronic sinusitis
What are the symptoms of bronchiectasis
Productive cough:
- Purulent sputum, daily large volume
- >6 weeks
- ± haemoptysis
- Chronic or moist cough unresponsive to 4wks of Abx
Breathlessness, dyspnoea (on exertion)
Chest pain between exacerbations
Malaise
Fever
Weight loss
Rhinosinusitis
*Symptoms often begin after an acute respiratory illness
What are the differentials for bronchiectasis
Asthma
COPD
Chronic sinusitis
Pneumonia
Lung cancer
Interstitial lung disease
Hypersensitivity pneumonitis
Pulmonary fibrosis
Sarcoidosis
TB
What are the signs of bronchiectasis on examination
Obs: ?sats
Weight and height
Respiratory:
- Clubbing
- Chest deformity and hyperinflation
- Coarse crepitations (usually at the base) that may shift with coughing
- Wheeze or high-pitch inspiratory squeaks
- Large airway rhonchi (low pitched snore-like sounds)
- Palpable chest secretions on coughing
What investigations should be done for bronchiectasis
Bedside: Sputum MC&S
Bloods: FBC, CRP, ESR, Blood gas, blood cultures, Alpha-1 antitrypsin level, serum Ig, HIV serology
Other:
- CXR: dilated bronchi (parallel lines radiating from hilum to diaphragm/Tramline shadow), fibrosis, atelectasis, pneumonic consolidation, ring shadows, volume loss, air-fluid levels
- High resolution CT (HRCT): Signet ring sign, dilated bronchi with thickened walls
- Spirometry: reduced FEV1, elevated RV/TLC
± sweat chloride test
± rheumatoid factor, anti-CCP
What is the management for chronic bronchiectasis
Refer to respiratory consultant
Lifestyle: Exercise + improved nutrition
Airway clearing:
- Airway clearance therapy
- Chest physiotherapy
- High frequency oscillation devices
- Inhaled bronchodilator, nebulised hypertonic saline
- Mucoactive agent e.g. carbocysteine
Infection prevention:
Frequent (>3/year) exacerbations → Prophylactic antibiotic courses (oral or aerosolised) - Azithromycin for 6 months*
Consider flu vaccination
What is the management for acute exacerbations of bronchiectasis
First line: 2x IV Abx (should cover for pseudomonas)
- amoxicillin/clarithromycin/doxycycline
- If pseudomonas +ve: Colistin
Bronchodilator e.g. salbutamol
Airway clearance therapy: hydration, postural drainage, percussion, vibration and oscillatory device usage
Physiotherapy, exercise and improved nutrition
Asthma/COPD: Inhaled corticosteroid e.g. fluticasone
Life threatening haemoptysis → Bronchial artery embolisation*
Severe: localised resection, lung or heart-lung transplant
What features necessitate for admission for bronchiectasis
Significant comorbidities
Cyanosis.
Confusion.
Marked breathlessness, rapid respiration, or laboured breathing.
Peripheral oedema.
Have a temperature of 38°C or higher.
What are the complications of bronchiectasis
Haemoptysis → life threatening
Persistent infection
Empyema
Pneumothorax
respiratory failure
Cor Pulmonale
Anxiety and depression
Urinary incontinence
Fatigue and reduced exercise intolerance
Nutritional deficiency → growth retardation
What is the prognosis for bronchiectasis
People with mild bronchiectasis can have a normal life expectancy
Approx. 50% of people will have 2 exacerbations a year, with 1/3 requiring hospitalisation
