Bronchiectasis

Question 1

What is the pathogenesis of bronchiectasis?

Answer 1

It is a chronic inflammation of thebronchi and bronchioles that causes permanent dilation and thinning of the airways

Question 2

What are the causes of bronchiectasis?

Answer 2

Congenital - cycstic fibrosis, primary ciliary dyskinesia
Post-infection - measles, pertussis, TB, pneumonia
Other - allergic, bronchial obstruction

Question 3

What are the symptoms of bronchiectasis?

Answer 3

Persistent cough with copious amounts of sputum

Intermittent haemoptysis

Question 4

What are the signs of bronchietasis?

Answer 4

Clubbing
Coarse insiratory crackles
Wheeze

Question 5

What investigations should be done to diagnose bronchiectasis?

Answer 5

Sputum - culture
CXR - cystic shadows, Tram line and ring shadows from thickened bronchioles
High res CT - distribution of disease
Spirometry - often obstructive pattern
Bronchoscopy - to locate haemoptysis site and exclude obstruction

Question 6

What is the management of bronchiectasis?

Answer 6

Chest phyio and mucolytics to clear chest (carbocystiene)
Antibiotics should be prescribed for exacerbations according to sensitivities
Bronchoddilators may be useful in coexisting disease e.g. asthma

Question 7

What is ABPA and how should it be treated?

Answer 7

This is allergic bronchopulmonary aspergillosis and is associated with bronchciectasis
Should be treated with corticosteroids and itraconazole