24. Bronchitis and bronchiectasis

Question 1

What is acute bronchitis?

Answer 1

Acute bronchitis is a lower respiratory tract infection characterized by inflammation of the bronchi, often following an upper respiratory tract infection (URTI) and usually caused by a virus.

Question 2

What are the clinical features of acute bronchitis?

Answer 2

• cough (resolves within 2-3 weeks),
• runny nose,
• headache,
• malaise,
• chest pain,
• wheezing heard on auscultation.

Question 3

What is the treatment for acute bronchitis?

Answer 3

• supportive management : adequate hydration and avoiding lung irritants
• symptomatic treatment : NSAIDs or paracetamol.

Question 4

What is chronic bronchitis?

Answer 4

Chronic bronchitis is the long-term inflammation of the bronchi, diagnosed based on clinical findings such as persistent productive cough for at least 3 consecutive months in at least 2 years.

Question 5

What are the clinical features of chronic bronchitis?

Answer 5

• chronic cough with sputum production,
• dyspnea on exertion,
• wheezing,
• recurrent respiratory infections,
• cyanosis and clubbing in advanced cases.

Question 6

What is the treatment for chronic bronchitis?

Answer 6

• smoking cessation,
• bronchodilators,
• inhaled corticosteroids,
• oxygen therapy,
• pulmonary rehabilitation.

Question 7

What is bronchiectasis?

Answer 7

Bronchiectasis is a chronic respiratory disease characterized by permanent/irreversible dilation of the bronchi and bronchioles

Question 8

What are the clinical features of bronchiectasis?

Answer 8

• chronic cough with purulent sputum,
• hemoptysis
• dyspnea,
• wheezing, crackles on auscultation
• clubbing.

Question 9

What is the treatment for bronchiectasis?

Answer 9

• Bronchopulmonary hygiene (hydration, drainage)
• long term antibiotic therapy
• surgical resection of bronchiectatic lung or lobectomy

Question 10

What is the pathogenesis of chronic bronchitis?

Answer 10

• Hypersecretion of mucus : smoking and air pollutants leads to hypertrophy of mucous glands and increases goblet cells in smaller bronchi and bronchioles.
• Airway obstruction is due to small airway disease induced by mucus plugging in the bronchial lumen, inflammation, and bronchiolar wall fibrosis.

Question 11

What are the possible complications of chronic bronchitis?

Answer 11

• May develop COPD with airflow obstruction accompanied by hypercapnia, hypoxemia, and cyanosis, known as “blue bloaters” (often have emphysema as well).
• With progression, can develop pulmonary hypertension and cardiac failure.

Question 12

What are the predisposing conditions for bronchiectasis?

Answer 12

• Bronchial obstruction due to tumor, foreign bodies, or mucus plugs,
• congenital/hereditary conditions such as cystic fibrosis, immunodeficiency states.
• necrotizing / suppurative pneumonia

Question 13

What are the two processes responsible for the pathogenesis of bronchiectasis?

Answer 13

Obstruction and chronic persistent infection.

Question 14

What is the confirmation diagnosis for bronchiectasis?

Answer 14

• Imaging, including chest X-ray and HRCT, which show bronchial dilation, thickened bronchial walls, and honeycombing.
• Spirometry
• Lab

Question 15

What are the congenital/hereditary conditions that can cause bronchiectasis?

Answer 15

Cystic fibrosis, immunodeficiency states, and Kartagener syndrome (primary ciliary dyskinesia).

Question 16

What is the diagnostic test for cystic fibrosis?

Answer 16

Sweat chloride test and/or genetic testing for CFTR mutations.

Question 17

What is the characteristic spirometry pattern seen in cystic fibrosis?

Answer 17

Obstructive pattern (decreased FEV1/FVC ratio).