3- bronchiectasis

Question 1

what is bronchiectasis?

Answer 1

• localised irreversible dilation of bronchial tree
• involved bronchi are dilated, inflamed and easily collapsible

= airway obstruction and impaired clearance of secretions

Question 2

what are clinical problems of bronchiectasis?

Answer 2

chronic sputum production and recurrent infections

Question 3

what is presentation of bronchiectasis?

Answer 3

• recurrent chest infections
• recurrent antibiotic prescriptions
• no response to antibiotics or short lived response to antibiotics

Question 4

why is it important to take thorough history when someone says they’ve got chest infection?

Answer 4

because lots of people have different ideas of what chest infection is

Question 5

what is aim of treatment for bronchiectasis? and why can that be disappointing?

Answer 5

treat infections and try and improve sputum clearance = means often don’t meet expectation of patients as not really proper cure like patients hope

Question 6

where are most bronchiectasis?

Answer 6

lower lobes
- only usually upper lobes in things like CF

Question 7

what can be seen on xray of bronchiectasis?

Answer 7

big white circle things that are dilated and thickened airways - shouldn’t be able to see at all
severe bronchiectasis = bronchus bigger than pulmonary artery it’s next to

Question 8

what is radiological definition of bronchiectasis?

Answer 8

Abnormally widened and thickened airway with an irregular wall, lack of tapering and/or visibility of the airway in the periphery of the lung

Question 9

what are some things that cause bronchiectasis?

Answer 9

• bronchial obstruction
• cystic fibrosis
• young’s syndrome
• katagener’s syndrome
• ABPA
• immunodeficiency
• rheumatoid arthritis
• bronchopulmonary sequestration
• mounier-khun syndrome
• yellow nail syndrome
• traction bronchiectasis associated with pulmonary fibrosis

Question 10

what is youngs syndrome?

Answer 10

primary cilia diskinesia (cilia dysfunction) → very rare
can have bronchiectasis

Question 11

what is kartagener’s syndrome?

Answer 11

particular primary cilia dyskinesia →situs inversus = heart on wrong side of body along with other organs on wrong side. when form, cilia rotate and push neurotransmitters certain ways and determines what is left and right

*can lead to bronchiectasis

Question 12

what is ABPA?

Answer 12

aspergillus disease, fungus that found in tayside a lot - with ABPA allergic response to aspergillus, eosinophilic inflammation usually →causes proximal bronchiectasis

Question 13

what is bronchopulmonary sequestration?

Answer 13

when part of lung (usually small section of lower lobe) gets blood supply directly from aorta rather than pulmonary trunk. some sort of developmental thing - treatment = take it out
= bronchiectasis occurs

Question 14

what is mounier-khun syndrome?

Answer 14

trachea bronchial malacia, rare →lack of cartilage in trachea and main bronchi either not born with or degrades over time, means collapse airways with wheeze and stridor
= bronchiectasis

Question 15

what is traction bronchiectasis associated with pulmonary fibrosis?

Answer 15

lung parenchyma thickness and contracts pulling open airways, end up with dilated airways but not thickened just dilated, the tissue is fibrotic = they don’t have infections they just have pulmonary fibrosis →important distinction

Question 16

what are 50% of causes of bronchiectasis?

Answer 16

iodiopathic = don’t really know why, just random

• can be very frustrating for patients →was it this , or this or this … will they pass it onto children?

Question 17

what is chronic bronchial sepsis?

Answer 17

early bronchiectasis
= people who have all hallmarks (like sputum etc) but no bronchiectasis on HRCT (CT scan)

• should send sputum

Question 18

what types of people are common to get bronchiectasis?

Answer 18

young women , especially who work in childcare
old people with asthma or COPD or other airways disease

Question 19

what investigations should be done for bronchiectasis?

Answer 19

• CT scan
• full blood count (eosinophilia, neutrophilia..)
• U&E’s = urine and electrolytes →shows if liver, kidney problems etc
• LFT = liver function test
• IgG,M,A
• functional antibodies
• aspergillus IgG/E and total IgE
• standard & mycobacterial cultures for everyone
• Consider Vasculitis screen and CTD screen - thinking about other things like rheumatoid arthritis

Question 20

what are functional antibodies?

Answer 20

= antibodies against pneumococcus, influenza, streptococcus (bacteria covered with sugar coat polysaccharide do need antibiotics that bind to polysaccharide in specific condition, can’t make antibody that binds to polysaccharide - rare but still he finds 5 or 6 a year, can replace antibodies for people) - if no spleen then can’t make functional antibodies so have to take antibiotics forever

Question 21

what are treatment options for bronchiectasis?

Answer 21

= MTD approach to holistic care

• stop smoking
• flu + covid vaccine
• pneumococcal vaccine
• reactive antibiotics (when sick do sputum example and then give antibiotic appropriate to most recent positive culture for 14 days)

Question 22

how long should you give antibiotics for infection?

Answer 22

5 days for normal people and 14 days for bronchiectasis

Question 23

what antibiotics should be given when colonised persistent bacteria 1st choice?

Answer 23

= means you can’t kill with antibiotic so just try control

1st choice = oral macrolide (azithromycin) antibiotic (think maybe interferes with signalling between bacteria).

azithromycin long term promotes resistance, also tinnitus + deafness, tachycardia (prolong QT)

Question 24

what are some strong antibiotics to use further down the line for colonised with persistent bacteria?

Answer 24

• nebulised gentamicin, colomycin, tobramycin = strong, work well against gram -ve (colomycin last ditch antibiotic when all else fails, not very nice, people don’t like)
• if still don’t feel well come in for 2 weeks for pulsed IV antibiotic response depending on bacteria colonising them = very unpleasant for people as long, boring in hospital

Question 25

what is anti-inflammatory antibiotics that are given to reduce exacerbation rate in bronchiectasis?

Answer 25

Low dose macrolide antibiotics have been shown to reduce exacerbation rates in bronchiectasis
→Clarithromycin 250 mg OD
→Azithromycin 250mg Three Times a Week (preferred)

Question 26

when is azithromycin ineffective?

Answer 26

in smokers

Question 27

what can be used to measure prognosis of bronchiectasis?

Answer 27

bronchiectasis severity index (BSI)