Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Irreversible, and abnormal dilatation of the bronchial tree caused by inflammation, mucus plugging and airway destruction.

Question 2

What are common causes of bronchiectasis?

Answer 2

Cystic fibrosis
Bronchial narrowing/obstruction (e.g. COPD, tumours)
Kartagener’s syndrome
Idiopathic (occurs in 50% of cases)

Question 3

What is the pathology in bronchiectasis?

Answer 3

An excessive inflammatory response leads to infection/obstruction within the airways, producing fibrotic change. The airways then dilate, as this scar tissue contracts.

This dilation makes mucociliary clearance much harder, thus chronic infection ensues.

Question 4

How does a patient with bronchiectasis typically present?

Answer 4

Patient will complain of recurrent chest infection-like episodes which do not clear up, despite having been prescribed multiple antibiotics previously.

Can also present with:
SOB
Wheeze
Haemoptysis (flecks)
Finger clubbing
Coarse crackles
Chronic productive cough

Question 5

What are complications of bronchiectasis?

Answer 5

Pneumonia
Pneumothorax
Pleural effusion

Question 6

How is bronchiectasis treated?

Answer 6

Through methods which improve mucociliary clearance. May be chest physiotherapy, or the insertion of a flutter valve.

If >3 exacerbations per year, long-term antibiotic may be indicated.

Important to treat underlying cause.

Question 7

What bacteria are commonly implicated in bronchiectasis exacerbations?

Answer 7

Haemophilus influenzae
Pseudomonas aeruginosa

Question 8

What conditions are linked to finger clubbing?

Answer 8

Think ‘CLUBBING’
Cyanotic heart disease
Lung disease (e.g. cancer, CF, IPF)
Ulcerative colitis/Crohn’s
Biliary cirrhosis
Birth defect
Infective endocarditis
Neoplasm (often Hodgkins Lymphoma)
GI malabsoprtion