[1] Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

A long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection

Question 2

What is the pathological process in bronchiectasis?

Answer 2

Chronic inflammation of the bronchi and bronchioles, leading to pernament dilation and thinning of the airways.

Question 3

What are the causes of bronchiectasis?

Answer 3

• Congential
• Post-infection
• Bronchial obstruction
• Allergic bronchopulmonary aspergillosis
• Hypogammaglobulinaemia
• Rheumatoid arthritis
• Ulcerative colitis
• Idiopathic

Question 4

What are the congential causes of bronchiectasis?

Answer 4

• Cystic fibrosis
• Young’s syndrome
• Primary ciliary dyskinesia

Question 5

What infections might bronchiectasis arise after?

Answer 5

• Measles
• Pertussis
• Bronchiolitis
• Pneumonia
• TB
• HIV

Question 6

What might cause bronchial obstruction leading to bronchiectasis?

Answer 6

• Tumour
• Foreign body

Question 7

What are the symptoms of bronchiectasis?

Answer 7

• Persistent cough
• Breathlessness
• Copious purulent sputum
• Intermittent haemoptysis

Question 8

What investigations into bronchiectasis should be performed?

Answer 8

• History and examination
• Sputum culture
• HRCT chest
• Spirometry
• Bronchoscopy

Question 9

What are the examination signs of bronchiectasis?

Answer 9

• Finger clubbing
• Coarse inspiratory crepitations
• Wheeze

Question 10

What does the chest x-ray show in bronchiectasis?

Answer 10

• Cystic shadows
• Thickened bronchial walls

Question 11

What is the purpose of bronchoscopy in bronchiectasis?

Answer 11

• Locate haemoptysis
• Exclude obstruction
• Obtain samples for culture

Question 12

How is bronchiectasis managed?

Answer 12

• Airway clearance techniques and mucolytics
• Antibiotics
• Bronchodilators
• Surgery

Question 13

What airway clearance techniques can be used in bronchiectasis?

Answer 13

• Active cycle of breathing techniques (ACBT)
• Postural drainage

Question 14

What do active cycle of breathing techniques involve?

Answer 14

Repeating a cycle made up of a number of different steps, including a period of normal breathing, followed by deep breaths, then coughing up mucus. The cycle is repeated for 20 to 30 minutes

Question 15

What is postural drainage?

Answer 15

Changing position to make it easier to remove mucus from the lungs

Question 16

How do devices used in bronchiectasis work?

Answer 16

They use a combination of vibrations and air pressure to make it easier to cough out any mucus

Question 17

Give three examples of devices used in bronchiectasis?

Answer 17

• Flutter
• RC cornet
• Acapella

Question 18

When might antibiotics be used in bronchiectasis?

Answer 18

If there is an acute exacerbation

Question 19

What antibiotics are given in an acute exacerbation of bronchiectasis?

Answer 19

A sample of sputum is used to determine bacterial sensitivity, however a broad spectrum antibiotic is used to cover until test results are available

Question 20

When might antibiotics be given prophylactically in bronchiectasis?

Answer 20

If a patient has three or more infective exacerbations in a year, or if the symptoms during an infective exacerbation are particularly severe

Question 21

When might bronchodilators be used in bronchiectasis?

Answer 21

In patients who have a particularly severe flare-up of symptoms. May also be useful in patients with COPD, asthma, CF, or ABPA

Question 22

When might surgery be used in bronchiectasis?

Answer 22

• When only affecting one section of the lung
• Symptoms aren’t responding to treatment
• There is an underlying condiiton that might cause bronchiectasis to reoccur

Question 23

What surgical treatment is used in focal bronchiectasis?

Answer 23

Lobectomy

Question 24

What are the complications of bronchiectasis?

Answer 24

• Pneumonia
• Pleural effusion
• Pneumothorax
• Haemoptysis
• Cerebral abscess
• Amyloidosis