10-9 DSA - Bronchiectasis by Kinder

Question 1

What is bronchiectasis?

Answer 1

Abnormal permanent dilatation of the bronchi and bronchioles caused by repeated cycles of airway infection and inflammation.

Question 2

What can lead to bronchiectasis?

Answer 2

Abnormalities of cilia, mucous clearance, mucus rheology, airway drainage, and host defenses can lead to bronchiectasis.

Question 3

How does bronchiectasis lead to lung destruction?

Answer 3

Patients develop chronic infections that lead to lung destruction.

Question 4

What are some common etiologies of bronchiectasis?

Answer 4

one third the etiology is unknown

One half have cystic fibrosis

Question 5

What are some infectious etiologies of bronchiectasis?

Answer 5

One third of patients with bronchiectasis have an infectious etiology, often years before disease onset.

Etiologies include childhood pertussis, TB, Mycobacterium avium-intracellulare. MAI usually involves the right middle lobe and lingula.

Question 6

What are some genetic etiologies of bronchiectasis?

Answer 6

cystic fibrosis,

primary ciliary dyskinesia, and

alpha 1 antitrypsin deficiency.

Question 7

What are some anatomical causes of bronchiectasis?

Answer 7

Anatomic causes include

esophageal dysfunction with aspiration,

COPD,

allergic bronchopulmonary aspergillosis,

endobronchial tumors,

extrinsic compression by lymph nodes, and

foreign bodies.

Question 9

What are some immune and autoimmune etiologies of bronchiectasis?

Answer 9

primary hypogammaglobulinemia,

immunoglobulin G deficiencies,

HIV,

Sjogren’s syndrome, and

rheumatoid arthritis.

Question 10

What are the symptoms of bronchiectasis?

Answer 10

chronic cough with purulent sputum, dyspnea, intermittent hemoptysis, pleuritic chest pain, weight loss, and fatigue.

Some patients have few symptoms and others have daily cough productive of sputum

Question 11

What are physical exam findings in bronchiectasis?

Answer 11

wheezing and crackles

Question 12

How rapid is the decline in pulmonary function with bronchiectasis?

Answer 12

Usually patients have a slow decline in pulmonary function,

but decline is more rapid in patients with Pseudomonas aeruginosa

Question 13

What imaging is ordered to make the Dx of bronchiectasis?

Answer 13

high resolution CT

Question 14

What findings on high resolution CT are consistent with bronchiectasis?

Answer 14

lack of bronchial tapering, bronchi visible in the peripheral 1 cm of lungs, and an internal bronchial diameter greater than the diameter of the accompanying bronchial artery.

Question 15

What parts of the lung predominate with what etiology of bronchiectasis?

1. CF
2. Aspiration
3. MAI
4. ABPA

Answer 15

Upper lobe predominance is seen with cystic fibrosis

lower lobe predominance in aspiration

right middle lobe and lingular lobe predominance with MAI infections

central bronchiectasis with allergic bronchopulmonary aspergillosis.

Question 16

What are the results of PFTs in someone with bronchiectasis?

Answer 16

obstruction

Question 17

What does bronchoscopy show in someone with bronchiectasis? What is it most helpful in?

Answer 17

used to detect airway abnormalities including tumors, structural deformities, and foreign bodies.

Most helpful with localized bronchiectasis

Question 18

What are some other tests that are helpful in dx’ing bronchiectasis, or at least the etiology of it?

Answer 18

serum immunoglobulin levels,

genetic disease screening,

sweat chloride to diagnose cystic fibrosis,

electron microscopy of airway mucosal cilia to diagnose primary ciliary dyskiniseia

alpha 1 antitrypsin levels

rheumatoid arthritis and

sjogren’s syndrome screening.

Question 19

What is the tx for bronchiectasis?

Answer 19

1. Treat underlying condition
2. Specific antimicrobials
3. Anti-inflammatory – inhaled steroids, macrolide antibiotics
4. Mobilization of secretions – pharmacologic or mechanical
5. Surgery for localized or refractory disease
6. Transplantation for end stage disease