Bronchiectasis

Question 1

Bronchiectasis

What is it?

Answer 1

a condition where parts of the airways become enlarged, inflamed and at risk of collapsing

Question 2

Bronchiectasis

What can it be induced by?

Answer 2

• Infection
• Impaired host immune response
• Conditions such as tracheo/bronchomalacia
• Focal airway obstruction
• Smoking
• Genetic diseases, such as cystic fibrosis and primary ciliary dyskinesia

Question 3

Bronchiectasis

What are the classical clinical features?

Answer 3

• cough and production of purulent sputum
• dyspnea, wheezing and chest pain
• history of multiple resp infections

During acute exacerbations, sputum is more viscous and darker

Question 4

Bronchiectasis

How is it diagnosed?

Answer 4

clinically, but confirmation of airway dilatation on a MDCT is needed

Question 5

Bronchiectasis

When diagnosing, it is also important to look for potentially treatable caused/infections and the distribution at CT of bronchiectasis may be helpful.

Complete these:
* Central/perihilar involvement: ________
* Upper lobe involvement: ________
* Middle/lower lobe involvement: ________
* Lower lobe involvement: ________

Answer 5

Central/perihilar involvement: suggestive of allergic aspergillosis
Upper lobe involvement: suggestive of cystic fibrosis
Middle/lower lobe involvement: suggestive of primary ciliary dysfunction
Lower lobe involvement: suggestive of idiopathic bronchiectasis

Question 6

Bronchiectasis

What are some investigations that are done, and why? (lab tests)

Answer 6

• FBC
• Immunoelectrophoresis to look for any immunodeficiencies
• Testing for cystic fibrosis (either sweat test or mutation analysis)
• Sputum culture to look for potential pathogens

Question 7

Bronchiectasis

What might be seen on a CXR?

Answer 7

CXR
- atelectasis
- a “tram track” sign
- opacities in the periphery
(non-specific)

Question 8

Bronchiectasis

What might be seen on a MDCT? When is an MDCT indicated?

Answer 8

MDCT:* indicated if CXR is normal or if it is abnormal and bronchiectasis is suspected*.

Airway dilatation, which confirms the diagnosis of bronchiectasis, can be seen if:
- Bronchoarterial ratio > 1
- No tapering of bronchi
- Distance from airway to costal pleural surface < 1 cm or airway touching mediastinal pleura

Question 9

Bronchiectasis

How might the results of a pulmonary function test be?

Answer 9

spirometry:
- potentially normal , but in severe bronchiectasis, obstructive pattern is common

Question 10

Bronchiectasis

What is the overall aim of management? (prescribing)

Answer 10

• decreasing inflammation and reducing and managing potential infections
  Mucolytic agents and hydration may help patients clear secretions.

Question 11

Bronchiectasis

Which ABxs do we use under these conditions?

No sputum analysis available: ____
No resistant organisms: ____ or ____
Beta-lactamase-positive organisms: ____, ____, ____ (2nd or 3rd generation), ____
Sensitive Pseudomonas: ____
Resistant Pseudomonas: ____

Answer 11

• No sputum analysis available: oral fluoroquinolone
• No resistant organisms: oral amoxicillin or macrolide
• Beta-lactamase-positive organisms: oral amoxicillin-clavulanate, fluoroquinolone, cephalosporin (2nd or 3rd generation), macrolide
• Sensitive Pseudomonas: oral ciprofloxacin
• Resistant Pseudomonas: hospital admission and IV administration of an appropriate antibiotic based on the sensitivity profile

Question 12

Bronchiectasis

Since bronchiectasis is the result of bronchial injury from prior infections or pathologies, treatment of the causative disease is usually not possible or ineffective.

What preventative can be used to stop the progression of bronchiectasis?

Answer 12

• Treatment of nontuberculous mycobacteria (NTM)
• Primary immunodeficiencies: treatment with intravenous immunoglobulins (IVIG)
• Allergic bronchopulmonary aspergillosis: treatment with glucocorticoids and antifungals

Question 13

Bronchiectasis

How long is the course of ABx for pt with few and recurrent exacerbations?

Answer 13

• Duration of therapy ranges from about 10 to 14 days for patients with few exacerbations.
• Long-term antibiotic therapy is recommended as preventative treatment if patients have recurrent exacerbations (i.e. > 2-3 per year).

Question 14

Bronchiectasis

Why do we use ABx?

Answer 14

Treatment with antibiotics may reduce inflammation in the airways and bacterial load during an acute exacerbation.

Question 15

Bronchiectasis

What is the managment? (non-prescribing)

Answer 15

• airway clearance therapy (bronchial hygiene)
• surgery (remove damaged lobes or control haemoptysis
• resolutive surgery -> bilateral lung transplant
• stent or tracheobronchoplasty for pt with tracheobronchomegaly
• help for pt with dysphagia or GORD may need help to avoid exacerbations

Question 16

Bronchiectasis

Detecting the presence of what pathogen changes the prognosis and management?

Answer 16

psuedomonas

Question 17

Bronchiectasis

What is the only ORAL abx that can be give to treat pneudomonas infection?

Answer 17

ciprofloxacin

(otherside need IV)