Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Chronic irreversible dilatation of one or more bronchi or bronchioles

Question 2

Describe the bronchi in bronchiectasis

Answer 2

• irreversible dilatation
• poor mucous clearance > stagnant pools
• predisposition to chronic or recurrent bacterial infection

Question 3

How does chronic inflammation cause bronchiectasis?

Answer 3

Inflammation causes destruction of the elastic and muscular components of the bronchial wall > irreversible dilatation

Question 4

Primary cause of bronchiectasis in the western world

Answer 4

Congenital conditions

Question 5

Classic findings in CXR of bronchiectasis

Answer 5

Dilated bronchi with thickened walls
(Tram track sign)

Question 6

What is imaging is used to investigate bronchiectasis

Answer 6

CT
CXR

Question 7

Classic finding on a CT scan of a patient with bronchiectasis

Answer 7

• signet ring sign: bronchial dilatation bigger than adjacent blood vessels
• bronchial wall thickening

Question 8

What is the signet ring sign?

Answer 8

Dilated bronchus (bigger) + accompanying pulmonary artery branch (smaller)

Question 9

Symptoms of bronchiectasis

Answer 9

• Chronic cough - most common
• daily purulent sputum production - most common
• fever
• breathlessness on exertion
• intermittent haemoptysis
• nasal symptoms
• chest pain
• fatigue
• wheeze - less common

Question 10

Signs of bronchiectasis

Answer 10

• hypoxaemia
• fever
• haemoptysis
• fine crackles (rales)
• high pitched inspiratory squeak
• rhonchi
• history of weight loss
• clubbing - less common

Question 11

What is rhonchi?

Answer 11

Continuous gurgling or bubbling sounds heard during inhalation and exhalation

Question 12

What is rales?

Answer 12

Fine crackles
Like Velcro being pulled apart

Question 13

Causes of bronchiectasis

Answer 13

• whooping cough
• TB
• idiopathic
• mucociliary clearance defects: cystic fibrosis, Young’s syndrome, Kartagerner syndrome
• hypogammaglobulinaemia
• alpha 1 antitrypsin deficiency
• obstructions (foreign body, tumour)
• rheumatoid arthritis
• inhalation of toxic gases

Question 14

Common organisms that cause bronchiectasis

Answer 14

• haemophilus influenzae
• streptococcus pneumoniae
• mycobacterium tuberculosis
• fungi: aspergillus, Candida albicans

Question 15

Management of bronchiectasis

Answer 15

• physio/ daily airway clearance
• inhaled corticosteroids + bronchodilators
• exclude immunodeficiency/ treat identifiable cause
• low dose macrolides
• annual flu vaccine
• routine vaccinations against Haemophilus influenzae + streptococcus pneumoniae

Question 16

Outline exacerbation in bronchiectasis

Answer 16

A person with bronchiectasis with deterioration in 3 or more key symptoms for at least 48 hours:
- cough
- sputum volume/consistency
- sputum purulence
- breathlessness
- fatigue
- haemoptysis

Question 17

What are low dose macrolides?
What is the mechanism of action?
Examples

Answer 17

• Antibiotics with anti inflammatory and antibiotic effect
• Inhibits protein synthesis 50s
• e.g. Clarithromycin + erythromycin

Question 18

What additional infections can occur with bronchiectasis?

Answer 18

pseudomonas aeruginosa
non-tuberculous mycobacteria

Question 19

What three conditions make up Kartagener’s syndrome?

Answer 19

Bronchiectasis
Sinusitis
Situs inversus

Question 20

What three conditions make up Young’s syndrome?

Answer 20

Bronchiectasis
Sinusitis
Infertility in men

Question 21

How can you differentiate between COPD and bronchiectasis

Answer 21

• diminished breath sound only in COPD
• signet ring sign + thickened dilated airways only in bronchiectasis
• remember that patient with COPS may develop bronchiectasis