Broncheiectasis

Question 1

Determinants of Bronchiectasis

Answer 1

• housing
• lack of immunisations
• access to healthcare

-tobacco use or passively inhaled by children

• Foreign body aspiration
• whooping cough/measles
• Hospital admissions for lower resp. tract infection in 1st 2 years of life
• Recurrent or severe lower respiratory tract infection

Question 2

Aetiology of Bronchiectasis (3)

Answer 2

Inherited
Acquired (due to determinants) - most common in NZ
Related to other health conditions

Question 3

Pathophysiology of Bronchiectasis

Answer 3

Inflammatory response damages cilia –> bacteria stays in mucus of conducting zone and colonizes

Bacterial Microorganisms continue stimulating inflam response –> inhibition of ciliary function –> damage of smooth muscle and elastic tissue

Loss of smooth muscle tissue and elastic properties –> dilation of affected bronchioles

Unable to clear mucus out of dilated bronchioles well –> bacteria stays in mucus –> fuels host inflammatory response –> cycle continues

Question 4

Consequences of pathological changes of Bronchiectasis

Answer 4

Impaired mucociliary clearance:
-dilated pockets where cilia is impaired/inactive due to excess mucus –> bacteria colonises in mucus –> mucus obstruction –> airflow limitation

• Can result in mucus pooling –> atelectasis (small airway closure due to lack of ventilation)

Increase in muscle tone
-increase in muscle tone –> airflow limitation due to decrease cross-sectional diameter of bronchioles

Gas Exchange Abnormalities
- obstruction –> inadequate ventilation –> hypoxemia

Question 5

Clinical Feats. of Bronchiectasis (6)

Answer 5

• Persistent moist cough
• Sputum retention
• Blood in sputum
• SOB
• +/- Wheeze
• Periods when patient is well with minimal symptoms

Question 6

Progression of Bronchiectasis (5)

Answer 6

Increase WOB
Decreased exercise tolerance/deconditioning 
Incontinence
Chronic Hypoxemia
Affected quality of life