Bronchiectasis

Question 1

Definition of bronchiectasis

Answer 1

Permanent abnormal dilation in one or more lung bronchi
Excess mucus secreted and pools in dilated airways - more prone to infection
Similar symptoms to COPD but not airflow obstruction - not under COPD

Question 2

Pathogenesis of bronchiectasis

Answer 2

1. Impaired mucociliary clearance causes accumulation of secretions
2. Accumulation of secretions leads to infection by bacteria
3. Infection by bacteria causes increased mucus production, greater impaired ciliary performance, increased inflammatory response
4. Excessive inflammatory response causes tissue damage
5. Tissue damage produces dilated bronchi, loss of ciliated epithelium, impaired mucociliary clearance - back to step 1

Question 3

Causes of bronchiectasis

Answer 3

Idiopathic
Infection (usually in childhood)
CF
Immunodeficiency
Ciliary dysfunction
Allergic bronchopulmonary aspergillosis (ABPA)
Inflammatory conditions
Aspiration/obstruction

Question 4

Clinical presentation of bronchiectasis

Answer 4

All have wet cough, chronic sputum production
75% dyspnoea + wheeze
50% chest pain (usually MSK from cough - can be cardiac)
1/3 signs of chronic sinusitis + nasal polyps
Recurrent exacerbations common
50% haemoptysis (rarely life threatening) - pressure from coughing damages capillaries

Question 5

How bronchiectasis is diagnosed

Answer 5

Chestx-ray
High resolution computed tomography (HRCT) - CT
Bloods and sputum microbiology
Pulmonary function tests (not obstructive but can show lung function changes)

Question 6

Bronchiectasis appearance on X-ray and CT

Answer 6

X-ray - consolidation in bronchi
CT - bronchial wall dilation

Question 7

Types of bronchiectasis

Answer 7

Saccular - in large bronchi that become large + balloon-like (plugging of sputum, clusters of cysts, most severe, linked with CF)
Cylindrical - in medium bronchi and symmetrically dilated (most common, least severe)
Varicose - constrictions and dilations deform bronchi

Widespread or localised

Question 8

Symptoms of acute exacerbation

Answer 8

Change in sputum production (most common)
Increased dyspnoea
Increased cough - more productive
Temp over 38 degrees
Increased wheezing Malaise, fatigue, lethargy, decreased exercise tolerance
Reduced pulmonary function
X-ray changes consistent with new pulmonary process
Changes in chest sounds

Accuse exacerbation defined as having 4 symptoms
Patients good at managing bronchiectasis long term so can recognise exacerbation

Question 9

Bronchiectasis treatment and management

Answer 9

Physiotherapy - clear excess mucus, breathing exercises, postural drainage, manual techniques, encourage exercise
IV/oral/nebulised antibiotics
Bronchodilators
Steroids
Nasal sprays
Flue/pneumonia vaccinations
Surgery - lung transplant/lobectomy

Question 10

Bronchiectasis prognosis

Answer 10

Unclear - related to lung function/presence of infection
Better than COPD, worse than asthma - for hospital treated patients
Associated disease affects prognosis eg CF

Question 11

Epidemiology of bronchiectasis

Answer 11

Prevalence, incidence mortality increasing
Mean LOS 8.8 days
Females > males
60% diagnosis over 70yrs
Diagnosis more common in least-deprived populations