Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Airway disease characterized by:
chronic bronchial dilation
impaired mucuociliary clearance
frequent bacterial infections.

Question 2

What is the aetiology of bronchiectasis?

Answer 2

Severe inflammation in lung causes fibrosis + dilation of the bronchi.
Followed by pooling of mucus, predisposing to further cycles of infection, damage + fibrosis to bronchial walls.

Question 3

Other than idiopathic list 5 causes of bronchiectasis

Answer 3

Post-infectious: severe pneumonia, whooping cough, TB.
Host defence defects: Kartagener s syndrome, CF, immunoglobulin deficiency
Obstruction of bronchi: Foreign body, enlarged lymph nodes.
Gastric reflux disease.
Inflammatory disorders: RA

Question 4

List 6 symptoms of bronchiectasis

Answer 4

Productive cough with purulent sputum/ haemoptysis.
Breathlessness
Chest pain
Malaise
Fever
Weight loss.
Symptoms usually begin after an acute respiratory illness.

Question 5

List 3 signs of bronchiectasis

Answer 5

Finger clubbing
Coarse creptitations (at bases, shift with coughing)
Wheeze.

Question 6

What investigations should you perform for bronchiectasis? Which is the best diagnostic method?

Answer 6

Sputum: culture + sensitivity
CXR
High resolution CT: BEST diagnostic method.
Bronchography: determines extent of disease before surgery

Question 7

List 3 common organisms causing acute exacerbation of bronchiectasis

Answer 7

Haemophilus influenzae
Pseudomonas aeruginosa
Staphylococcus aureus

Question 8

What is seen on CXR in bronchiectasis?

Answer 8

Dilated bronchi seen as parallel lines radiating from hilum to diaphragm (‘tramline shadows’).
May also show fibrosis, atelectasis, pneumonic consolidations, or may be normal.

Question 9

What is seen on high res. CT in bronchiectasis?

Answer 9

Dilated bronchi with thickened walls.

Question 10

Describe the acute management of bronchiectasis

Answer 10

2 IV Abx with efficacy for Pseudomonas .

Question 11

Describe the chronic management of bronchiectasis

Answer 11

Inhaled corticosteroids (e.g. fluticasone) reduce inflammation + volume of sputum, (but not frequency of exacerbations or lung function)
Bronchodilators in patients with responsive disease.
Maintain hydration with adequate oral fluid intake.
Prophylactic Abx for those with frequent exacerbations.

Question 12

List 6 complications of bronchiectasis

Answer 12

Life-threatening haemoptysis
Persistent infections
Empyema
Respiratory failure
Cor pulmonale
Multi-organ abscesses.