3. Bronchiectasis, Asthma and Vasculitis Flashcards
What is bronchiectasis?
Abnormal, irreversible dilatation of bronchi, caused by the destruction of muscle and elastic tissue
Is bronchiectasis considered an obstructive or restrictive lung disease?
Obstructive (as bronchi are damaged)
What are the causes of bronchiectasis?
Infection Congenital Immunodeficiency Bronchial obstruction Rheumatic conditions
What are the infectious causes of bronchiectasis?
Post childhood bronchopneumonia or bronchiolitis
Pneumonia complication of measles or pertussis
Allergic bronchopulmonary aspergillosis
TB and mycobacterium avium
What are the congenital causes of bronchiectasis?
Primary ciliary dyskinesia
A1ATD
CF
Youngs, Marfan and Kantageners syndromes
What are the immune causes of bronchiectasis?
IgG and M deficiencies
Related to malignancy eg. myeloma
What are the bronchial obstruction causes of bronchiectasis?
Aspiration
Tumour
Mucous plugs in asthma
Compressive lymphadenopathy
How does bronchiectasis appear when looking at the lung?
Dilated bronchi containing thick secretions
Wall destroyed by chronic inflammation
Arteries increased in size
What is the pathogenesis of bronchiectasis?
Infection + impairment of drainage + airway obstruction
Bronchi collapse easily: obstruction and reduced clearance
What is the difference between bronchitis and bronchiectasis?
The wall is destroyed in bronchiectasis
What are the symptoms of bronchiectasis?
Productive cough
Dyspnoea and wheezing
Pleuritic chest pain
Recurrent LRTI
What are the physical findings in bronchiectasis?
Crackles
Coarse crepitations
Rhonchi
Clubbing
What are the complications of bronchiectasis?
Haemoptysis
Respiratory failure
Brain abscesses due to septic emboli
Secondary amyloidosis
What are the investigations into bronchiectasis?
FBC and U&E Sputum and blood culture CXR and CT thorax Bronchoscopy for obstruction Pulmonary Function Tests
How is bronchiectasis treated?
Treat infection and reduce risk factors Vaccinate Chest physio to clear secretions Nebulised DNAse to clear airways Nebulised antibiotics Surgery if an aspirated foreign body
What is a pleural effusion?
Accumulation of fluid in the pleural space
Name 3 types of pleural effusion
Empyema: infected fluid
Transudative
Exudative
What are the causes of transudative effusions?
Heart failure, fluid overload, nephrotic syndrome, peritoneal dialysis, hepatic cirrhosis
What are the causes of exudative effusions?
Infection
Malignancy
Pulomary emboli
What are the symptoms of pleural effusion?
Dyspnoea
Pleuritic chest pain
Cough and haemoptysis
Weight loss
What are the signs of pleural effusion?
Decreased breath sounds over site
Bronchial breath sounds immediately above site
Dull on percussion
Absent or decreased tactile fremitius
What investigations should be taken into pleural effusion?
CXR +/- CT thorax
Blood test
Thoracocentesis
What investigations can be done on pleuritic fluid from thoracocentesis?
Gross examination: blood, cloudy, malodorous
Ratio of pleural fluid protein: serum protein
Glucose, LDH, amylase
Cytology
Culture and sensitivity
What is the usually appearance of pleural fluid?
Thin and yellow
What is asthma?
Episodic, reversible bronchospasm in response to a stimulus
What mediators are involved in asthma?
IL3, 4, 5
IgE
Histamine
Leucotrienes
What drugs can induce asthma?
Aspirin NSAIDs Antibiotics Beta-blockers ACE-inhibitors
What is Samter’s triad?
Aspirin sensitivity
Asthma
Nasal polyps
What disease is intrinsic asthma associated with?
COPD
What are the microscopic features of asthma?
Airway infiltration by neutrophils and eosinophils
Mast cell degranulation (histamine release)
BM thickening
Loss of epithelial integrity
Occlusion of bronchi
Mucous
Hyperplasia and hypertrophy of bronchial smooth muscle and goblet cells
How should a PE be managed?
Oxygen and pain relief
Thrombolytic therapy
Long term anticoagulants
Embolectomy
What are the consequences of diffuse alveolar haemorrhage?
Haemoptysis
Anaemia
Diffuse pulmonary infiltrates
What are the causes of diffuse alveolar haemorrhage?
Primary immune-mediated diseases
Necrotising pneumonia
Bleeding diathesis
Passive venous congestion
What types of vasculitis affect the lung?
GPA
EGPA
Collagen vascular disorders
What effect does anti-GBM disease have on the lungs?
Focal necrosis of alveolar walls and intra-alveolar haemorrhage
Fibrous thickening of septum in alveoli
In acute phase, macrophages are haemosiderin laden as they try to clean up blood
How is anti-GBM disease managed?
Plasmaphoresis
Immunosuppressive therapy
How is GPA managed?
Cyclophosphamide and glucocorticosteroids
Rituximab
Plasma exchange
How does GPA present?
Recurrent RTIs
Fever, night sweats, weight loss, fatigue
Conjunctivitis
What effect does EGPA have on the lungs?
Severe asthma
Eosinophilia
What investigations should be done into EGPA?
Eosinophilia in FBC and BAL
High IgE
RF low positive
What effect do collagen vascular disorders have on the lungs?
Interstitial pneumonia Pulmonary hypertension Pulmonary vasculitis Diffuse Alveolar Haemorrhage Pleuritis
