8. Bronchiectasis Flashcards
What is the definition of bronchiectasis?
Chronic irreversible dilation of one or more bronchi - pathological condition can be caused by many diseases or be idiopathic
These deformed bronchi exhibit poor mucous clearance and there is predisposition to recurrent or chronic bacterial infection
What is the aetiology of bronchiectasis?
Variety of underlying causes with a common underlying mechanisms of chronic inflammation
What does the CXR look like in bronchiectasis?
Usually abnormal but may be normal in early disease
Classic abnormality - dilated bronchi with thickened walls
Inadequate in diagnosis
What does a CT show in bronchiectasis?
Demonstrates bronchial dilation germ than the adjacent blood vessel, bronchial wall thickening
Diagnoses
What is the signet ring sign?
Dilated bronchus and accompanying pulmonary artery branch are seen in cross section
Bronchus is markedly dilated compared to artery
What are the very common symptoms of bronchiectasis?
Chronic cough
Daily mucopurulent sputum production
What are the common symptoms of bronchiectasis?
Breathlessness on exertion Intermittent haemoptysis Nasal symptoms Chest pain Fatigue
What are less common symptoms of bronchiectasis?
Wheeze
What are the clinical signs of bronchiectasis?
Pulse oximetry - hypoxaemia in advanced cases Fever relatively common Haemoptysis - mild Fine crackles High pitched inspiratory squeaks Rhonchi History of weight loss
What are the causes of bronchiectasis?
Post-infective - whooping cough, TB Immune deficiency - hypogammaglobulinaemia Mucociliary clearance defects - CF, primary ciliary dyskinesia Alpha-1-antitrypsin deficiency Obstruction Toxic insult Idiopathic Secondary immune deficiency
What are the common organisms in bronchiectasis?
Haemophilus influenzae Pseudomonas aeruginosa Stenotrophomonas maltophilia Streptococcus pneumoniae Fungi - aspergillosis, candida Mycobacteria tuberculosis
What do pulmonary function tests show in bronchiectasis?
Obstructive airways disease pattern FEV1:FEV <0.7
Elevation of RV:TLC consistent with air trapping
DLCO reduced in severe disease
What is the management for bronchiectasis?
Physio/airways clearance - daily Sputum sampling Exclude immunodeficiency/treat identifiable causes Consider long-term therapies Annual flu and routine vaccinations
What is an acute exacerbation in bronchiectasis?
A person with deterioration in 3 or more key symptoms for at leats 48 hours:
- cough
- sputum volume and/or consistency
- sputum purulence
- breathlessness
- fatigue
- haemoptysis
