3. Bronchiectasis Flashcards
Define Bronchiectasis.
It is the abnormal permanent dilatation of the Bronchi.
The presence of …….. leads to Bronchiectasis.
- Respiratory infection
- Defect in the host’s defence
- Impairment of drainage
- Airway obstruction
State 3 common aetiologies of Bronchiectasis.
- Infections (Bacterial, Mycobacterial, A.BP.A)
- Airway obstructions (Intraluminal tumours, L.N, COPD)
- Immunodeficiency (Ciliary dyskinesia, HIV, Cystic fibrosis)
What are the common causes of Bronchiectasis in developed countries?
- Cystic fibrosis
- Smoking
- COPD
What are the common causes of Bronchiectasis in developing countries?
- Bacterial infections in childhood
- Tuberculosis
- Airway obstruction
- Smoking
- COPD
State other causes that may lead to Bronchiectasis.
- Aspiration
- Primary Ciliary Dyskinesia
- Allergic Bronchopulmonary Aspergillosis (ABPA)
- Alpha-1 Antitrypsin deficiency
- Connective Tissue disorders
State the pathology usually seen in Bronchiectasis.
It usually affects the lower lobes, bilaterally. The bronchi and bronchioles are dilated up to 4x the normal size.
State the 3 morphological types of Bronchiectasis.
- Cystic type (most common)
- Cylindrical type (2nd commonest)
- Varicose type (rare)
What is Kartagener’s Syndrome?
It is a triad of Sinusitis, Bronchiectasis, and Situs Inversus.
What are the clinical features seen in Bronchiectasis patients?
- Cough with daily mucopurulent expectoration lasting from months to years
- Weight loss
- Weakness
- Occasional hemoptysis
- Dysapnea
- Bronchospasm
A post-tubercular patient presents to the OPD with non-productive cough. What is your probable diagnosis?
Dry Bronchiectasis (bronchiectasis sicca)
What are the common signs observed in Bronchiectasis patients?
- Coarse crackles (in lung bases)
- Wheezing (indicates active infection)
- Clubbing of Fingers
- Cyanosis
A patient on examination has coarse crackles in the Upper Lobe areas of his Lungs. What do you conclude from this finding?
Post-Tubercular Dry Bronchiectasis
What do you think coarse crackles indicate?
They indicate dilated bronchioles and presence of purulent material.
How do you confirm your diagnosis of Bronchiectasis?
By sending the patient for imaging.
What tests would you suggest for imaging of a Bronchiectasis patient?
- High Resolution CT of Thorax
- Chest X-Ray
- Bronchoscopy
What is usually seen in a Chest X-Ray of a Bronchiectasis patient?
- Increased pulmonary markings
- Cystic spaces
- Honeycombing
What lab tests would you carry out in a suspected case of Bronchiectasis?
- Total WBC Counts
- Sputum analysis
- Alpha-1 Antitrypsin Levels
- Autoimmune Screening Tests
What are the goals of treatment for Bronchiectasis?
- Improve symptoms
- Reduce complications
- Control exacerbations
What would you advise a patient with Bronchiectasis?
- Stop smoking and avoid passive smoking
- Ensure adequate nutrition is obtained
- Obtain Influenza and Pneumococcal vaccinations
What is the mainstay therapy for Bronchiectasis?
Antibiotic Therapy
What would you prescribe to a patient with mild-moderate bronchiectasis?
- Amoxicillin
- Azithromycin
- Fluoroquinolones
- Tetracyclines
*Administer orally
What would you prescribe to a patient with severe bronchiectasis?
- Aminoglycosides
- 3rd Generation Cephalosporins
- Antipseudomonal Penicillins
- Fluoroquinolones
*IV administration
Beside the mainstay therapy, what other treatment regimes would you consider for treating Bronchiectasis?
- Bronchial Hygiene through chest physiotherapy and mucous drainage
- Bronchodilators
- Mucolytic agents
- Surgical resection or Transplantion
What are the complications likely to occur in a Bronchiectasis patient?
- Recurrent Pneumonia
- Empyema
- Lung Abscess
- Recurrent/Massive hemoptysis
- Progressive Respiratory Failure
- Cor pulmonale
