82R. Bronchiectasis Flashcards
what is bronchiectasis
localised irreversible dilation of the bronchial tree
airflow obstruction
impaired clearance of secretions
describe the bronchi in bronchiectasis
dilated
inflamed
easily collapsible
what are the presentations of bronchiectasis
recurrent chest infections
recurrent antibiotic prescriptions
no response to antibiotics
short lived response to antibiotics
sputum production
SOB
on a CT scan how would you identify bronchiectasis
if the bronchiole is bigger than the pulmonary artery next to it (looks like a signet ring)
what tests do we not do anymore for bronchiectasis
bronchogram - they are very unpleasant
what is the radiological definition of bronchiectasis
abnormally widened and thickened airway with an irregular wall, lack of tapering and or visibility of the airway in the periphery of the lung
name some of the pathophysiology’s of Bronchiectasis
- bronchial obstriction
- CF
- Youngs Syndrome
- Kartanager’s syndrome
- ABPA
-immunodeficincy
-Rheumatoid arthritis - Bronchopulmonary sequestration
- Mounier Khun Syndrome
- Yellow nail syndrome
- Traction Bronchiectasis
what percentage are bronchiectasis idiopathic
%50
what is Kartanagers syndrome
heart on the wrong side/organs on the wrong side- cilia rotate- cytus inversus
what is Bronchopulmonary sequestration
when blood doesnt supply a lung lobe normally
what is Mounier Khun syndrome
no cartilage in bronchi or break down of cartilage of cartilage
what disease is associated with young women who work in childcare
persistent bacterial bronchitis/ chronic bronchial sepsis
what are HRCT scans
High-Resolution Computed Tomography. It’s a special type of CT scan that provides very detailed images of your lungs
if you have all the hallmarks of bronchiectasis but no bronchiectasis on a HRCT. what do you have
persistent bacterial bronchitis/ chronic bronchial sepsis
aside from young women who work in childcare, who else gets persistent bacterial bronchitis/ chronic bronchial sepsis
older COPD patients
what investigations do you do for bronchiectasis
HRCT chest
FBC/U&Es, LFT
IgG/M/A
Functional antibodies
aspergillus IgG/IgE and total IgE
Standard and Mycobacterial Cultures
Consider Vasculitis screen and CTD screen
how do you treat bronchiectasis
stop smoking
flu vaccine
pneumococcal vaccine
reactive antibiotics
how many days of antibiotic
14 days
What Antibiotic Therapy should be used =
When colonised with persistent bacteria
→ Oral macrolide antibiotic ........... → Nebulised .................................. → ........IV abx
azithromycin
gentamicin, colomycin, tobramycin
Pulsed
what anti inflammatory treatment is used in bronchiectasis
low dose macrolide
- clarithromycin
- azithromycin
what side effects come with azithromycin
tinnitus / deafness in men from 70-80
who are low dose macrolides used in bronchiectasis anti inflammatory not effective in
smokers
how do you treat acute exacerbations of bronchiectisis
2 weeks of antibiotics
what is the prognosis of bronchiectasis
- Bronchiectasis Severity Index
- Bronchiectasis Aetiology and Co-morbidity Index
what kind of ‘working’ is the best in treating chronic pulmonary infection
MDT - multi disciplinary team
Nurses, pharmacists, resp physicians, radiologists, microbiologists , ID physicians, physiotherapists
what is the approach to the patient with bronchiectasis
- Thorough history
When, why, by whom, was the diagnosis made? Do we agree with the diagnosis?- Review the imaging – HRCT, and ideally a previous one
- Aetiology
We are rigorous in our aetiological testing, we have a high diagnostic yield (~ 50%)
Treat the underlying pathology, there is one - Physiotherapy
Airway clearance is the mainstay of therapy in bronchiectasis
ACBT, Huffing, AD - Microbiology
This is key – what are the infected with, colonised with, and how is it progressing?
Devise a clear plan for antimicrobial therapy - Fungus
Dr Connell will go through fungal infection and complications with you later
We test everyone, and have a low threshold for bronchoscopy to search for aspergillus - Non-tuberculous Mycobacteria
Dr Connell will go through NTM with you later
We have close liaison with the national reference lab, and follow up every positive NTM culture through our MDT - Ongoing discussion
Feedback and follow up from the whole team
what is the very rare cause of bronchiectasis.
that You’ll only find it, if you look for it
Primary Ciliary Dyskinesia
