Bronchiectasis

Question 1

Define bronchiectasis

Answer 1

Lung airway disease characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections. There is wall destruction, loss of cilia and increased mucus.

Question 2

Explain the aetiology and risk factors of bronchiectasis

Answer 2

Pathophysiology: chronic lung inflammation leads to fibrosis and permanent dilation of the bronchi. This leads to mucus pooling, which predisposes to bacterial infections and further damage and fibrosis.

Causes:

• IDIOPATHIC (50%)
• CONGENITAL: CF, Kartagener’s Synd (primary ciliary dyskinesia), Young’s Synd (azoospermia+ bronchiectasis+ rhinosinusitis)
• POST-INFECTIONS: measles, TB, pneumonia, whooping cough IMMUNODEFICIENCIES
• OBSTRUCTION OF BRONCHI: foreign bodies, enlarged LNs INFLAMMATORY DISORDERS: UC, RA, ABPA, Yellow nail synd GORD Risk factors: Toxic fumes, gases, smoke, and other harmful substances, infections, smoking etc

Question 3

Summarise the epidemiology of bronchiectasis

Answer 3

Commonly arises in childhood

Incidence decreased with use of AB 0.1% per year

Question 4

Recognise the symptoms of bronchiectasis

Answer 4

• Productive cough with purulent sputum or haemoptysis
• SOB
• Chest pain
• Malaise, fever, weight loss
• Usually after an acute resp illness

Question 5

Recognise the signs of bronchiectasis on physical examination

Answer 5

• Clubbing
• Coarse crepitations that move with cough
• Wheeze
• ±splenomegaly if immunodeficient

Question 6

Identify the appropriate investigations for bronchiectasits

Answer 6

BLOODS:

• serum IgE for aspergillus
• and for pneumococcal vaccine
• a1-AT levels

SPUTUM:

• MCS
• Common organisms: P.aeruginosa, H.influenza, S.aureus, S.pneumonia, Klebsiella, Mycobacteria

CXR:

• dilated bronchi (parallel lines going from hilum to the diaphragm - tramline shadows)
• fibrosis
• atelectasis
• consolidations
• reticulonodular, coarse lung markings
• may be NORMAL

High Res CT: best diagnostic method, thickened walls, saccular dilatations in cluster with pools of mucus

SPIROMETRY: obstructive pattern

BRONCHOGRAPHY: biopsy - rarely used

OTHERS: sweat test for CF, mucociliary clearance study

Question 7

Generate a management plan for bronchiectasis

Answer 7

Acute exacerbations: treat with 2 IV ANTIBIOTICS (Amoxicillin or Clari 500mg TDS, and Ciprofloxacin 500mg BD for pseudomonas)

Prophylactic antibiotics for frequent exacerbations

Inhaled Corticosteroids for inflammation - fluticasone Bronchodilators for responsive disease

Hydration

Education

Flu vaccination, pneumonia vaccination

Physiotherapy: expectoration, drainage, rehab

Bronchial artery embolisation - if life-threatening haemoptysis Surgical - localised resection, lung or heart transplantation

Question 8

Identify the possible complications of bronchiectasis

Answer 8

• Life-threatening haemoptysis
• Persistent infections
• Empyema
• Multi-organ abscesses
• Respiratory failure
• Pulmonary HTN
• Amyloidosis
• Pleural effusion
• Pneumothorax
• Cor Pulmonale

Question 9

Summarise the prognosis for patients with bronchiectasis

Answer 9

Most px have symptoms 10 years after