Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

permanent dilation of the airway secondary to infection or inflammation

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

What is the most common cause of bronchiectasis?

Answer 3

Severe lower Respiratory tract infection:
pneumonia
pertussis
pulmonary TB
mycoplasma
influenza

Question 4

List 7 causes of bronchiectasis

Answer 4

Post-infectious: TB, measles, pertussis, pneumonia
Cystic fibrosis
Bronchial obstruction: lung cancer/ FB
Immune deficiency: selective IgA, hypogammaglobulinaemia
ABPA
Ciliary dyskinetic syndromes: Kartagener’s + Young’s
Yellow nail syndrome

Question 5

What chronic inflammatory conditions are associated with bronchiectasis?

Answer 5

CTDs: RhA
IBD: UC > Crohns

Question 6

List 3 symptoms of bronchiectasis

Answer 6

Productive cough with large vol purulent sputum >8w
Dyspnoea
Haemoptysis

Question 7

List 3 signs of bronchiectasis

Answer 7

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

Question 8

What initial investigations should you perform for bronchiectasis?

Answer 8

Sputum culture: ID colonising pathogens
CXR: r/o other pathology
Spirometry: assess severity of airflow obstruction
O2 Sats
FBC
+ refer to a resp consultant

Question 9

What investigations for bronchiectasis are performed in secondary care?

Answer 9

High resolution CT: diagnostic
Ix for underlying cause: sweat test (CF), Ab deficiency, PCD

Question 10

List 4 common organisms isolated from patients with bronchiectasis

Answer 10

Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae

Question 11

What is seen on CXR in bronchiectasis?

Answer 11

Dilated non-tapering bronchi: parallel lines radiating from hilum (tram tracks).
Ring shadow: bronchi end on +/- fluid levels
Increase in bronchovascular markings

Question 12

What is seen on high res. CT in bronchiectasis?

Answer 12

Dilated bronchi with increased bronchoarterial ratio: Signet ring sign (vertically oriented bronchi)
Lack of tapering
Visibility of peripheral airways within 1cm of costal pleura

Question 13

Describe conservative management of bronchiectasis

Answer 13

Exercise (form of airway clearance) + improved nutrition
Airway clearance therapy with respiratory PT
Smoking cessation advice

Question 14

What does airway clearance therapy involve?

Answer 14

Maintenance of oral hydration
Percussion, breathing or coughing strategies
Positioning + postural drainage
Positive expiratory pressure devices + oscillatory devices

Question 15

What medical management may be used in bronchiectasis?

Answer 15

Bronchodilator (Salbutamol) if asthma-type response

Mucoactive agent: nebulised hypertonic saline, promotes clearing by inducing coughing

Question 16

What vaccinations are offered to patients with bronchiectasis?

Answer 16

Pneumococcal
Influenza: Annually

Question 17

List 6 complications of bronchiectasis

Answer 17

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

Question 18

How does an acute exacerbation of bronchiectasis present?

Answer 18

Worsening of cough
Change in sputum colour
Increase in sputum volume
Fever +/or Malaise

Question 19

Which antibiotic is used against pseudomonas aeruginosa and Klebsiella in an acute exacerbation of bronchiectasis?

Answer 19

Ciprofloxacin

Question 20

If previous micro cultures are unknown, which antibiotic is used in an acute exacerbation of bronchiectasis?

Answer 20

Amoxicillin

(If pen allergic Clarithromycin or Doxycycline)

Question 21

In patients at higher risk of treatment failure in an acute exacerbation of bronchiectasis, what antibiotic should be used instead of amoxicillin?

Answer 21

Co-amoxiclav

Question 22

When is surgery used in bronchiectasis?

Answer 22

Localised disease + Sx not controlled by optimal medical Mx
OR
Massive haemoptysis

Question 23

Which antibiotic may be used for long term prophylaxis in bronchiectasis? When is this indicated?

Answer 23

Azithromycin
if 3 or more exacerbations per year despite maintenance Tx