Bronchieactasis Flashcards
What is bronchiectasis?
Irreversible dilation of one/multiple bronchi characterized by a foul-smelling productive cough, recurrent chest infections, and airflow obstruction.
What causes inflammation in bronchiectasis?
Initial damage to airways from infection, autoimmune conditions, or trauma, driven by neutrophils. which causes excess mucus production which induces dilatation of the bronchioles and destruction of the walls, causing widening of the airways.
Bronchial neovascularisation occurs with hypertrophy of the bronchial arteries that can cause intermittent haemoptysis.
List some conditions that increase the risk of bronchiectasis.
- Cystic fibrosis
- Tumor
- Foreign body aspiration
- Alpha-1 trypsin deficiency
- Primary ciliary dyskinesia
- Airway obstruction from COPD and asthma
- Recurrent infection
- bronchial obstruction with foreign body, mucus plug, tumours or hilar lymphadenoapthy
*Allergic bronchopulmonary aspergillosis
What is the pathophysiology of Bronchieactasis?
The inflammation causes erosion of the bronchial arteries, resulting in haemoptysis. The mucus plug reduces air entering the lungs, resulting in a V/Q mismatch and causes hypoventilation, causing Type II respiratory failure. The chronic hypoxia in Bronchieactasis can lead to pulmonary artery hypertension and right side of the heart to be overloaded. These patients are at greater risk of recurrent infection.
What are the complications with Bronchieactasis?
Complications with Bronchieactasis include pneumothorax, infective exacerbation, haemoptysis, respiratory failure and amyloidosis.
Which bacteria is associated with cystic fibrosis?
Pseudomonas aeruginosa.
Which bacteria is associated with COPD?
Haemophilus influenzae.
What are the symptoms of bronchiectasis?
- Recurrent infections
- Progressive dyspnea
- Intermittent wheezing
- Hemoptysis
- Pleuritic chest pain
- Fatigue
- Weight loss
What is allergic bronchopulmonary aspergillosis?
Allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to the fungus aspergillus fumigatus mediated by IgE, cell mediated or immune complex which causes airway inflammation and increased mucus production that results in Bronchieactasis. This fungus is typically inhaled in the environment, however immmunocompromised individuals and patinets with COPD and asthma are at greater risk.
What are the features of allergic bronchopulmonary aspergillus?
It is characterised by high eosinophil count and transient infiltrates on CXR; presentation is asthmatics with uncontrolled asthma despite optimum treatment, productive cough with brown mucus plugs, haemoptysis, pleuritic chest pain and fever.
How is allergic bronchopulmonary aspergillus diagnosed?
Diagnosis is through sputum stain and culture, showing branching septal hyphae with skin prick test for IgE. This can result in atelectasis over time due to mucous impaction.
What is the treatment for allergic bronchopulmonary aspergillus?
It is typically treated with corticosteroids, anti-fungal medications like itraconazole.
Patients present with asthma-like symptoms, raised IgE, eosinophilia and hyphae in sputum and positive skin prick test.
What are the diagnostic tests for Bronchieactasis?
CXR
Pulmonary function test
High resolution CT scan -> gold standard
Specific tests for underlying conditions are antibody count, immunodeficiency test and bronchoalveolar ratio
What does a high-resolution CT scan show in bronchiectasis?
Bronchial dilatation with wall thickening.
What does CXR show for Bronchieactasis?
Shows tram-track opacities sign where there is dilated airways, visibility of airways towards the lungs peripheral
What does the pulmonary function test show for Bronchieactasis?
PFT( pulmonary function test) will show reduced FEV1/FVC ratio and increased residual; volume, indicating airflow obstruction and trapping
Fill in the blank: The gold standard for diagnosing bronchiectasis is a _______.
[high-resolution CT scan].
What is the typical treatment for allergic bronchopulmonary aspergillosis?
- Corticosteroids
- Anti-fungal medications like itraconazole.
What are some complications of bronchiectasis?
- Pneumothorax
- Infective exacerbation
- Hemoptysis
- Respiratory failure
- Amyloidosis
What findings might be seen in a pulmonary function test for bronchiectasis?
Reduced FEV1/FVC ratio and increased residual volume.
What is a common characteristic of the cough in bronchiectasis?
Foul smelling and containing blood or a brown colour.
How is Bronchieactasis treated?
*Manage chronic inflammation via the underlying cause of *Bronchieactasis
*Chest physiotherapy
*Manage airflow obstruction with bronchodilators and corticosteroids
*Lifestyle modification with smoking cessation, vaccination against infleunza and pneumococcal disease
What is the role of chest physiotherapy in bronchiectasis treatment?
Active cycle of breahting to improve expiratory flow and mucus clearance.
Which antibiotic is best for haemophilius influenzae?
amoxicillin
Which antibiotic is best for pseudomonas aeruginosa?
fluroquinolone
What is the treatment for severe hemoptysis in bronchiectasis?
Bronchial artery embolization or surgical resection.
How is chronic antibiotic exacerbation treated?
Chronic suppressive antibiotics or intravenous antibiotic with aminoglycosides and anti-pseudomonal.
Which antibiotic class is ideal for managing Bronchieactasis?
Macrolide antibiotics should be considered due to immunosuppressive effects and decreasing mucus production and inhibits the pseudomonas virulence factors/
What is the significance of the sweat test in bronchiectasis?
It tests for chloride deficiency, commonly associated with cystic fibrosis.
What is the typical presentation of patients with allergic bronchopulmonary aspergillosis?
- Asthma-like symptoms
- Raised IgE
- Eosinophilia
- Hyphae in sputum
- Positive skin prick test
What is a potential long-term consequence of mucous impaction in allergic bronchopulmonary aspergillosis?
Atelectasis.
What lifestyle modifications are recommended for patients with bronchiectasis?
- Smoking cessation
- Vaccination against influenza and pneumococcal disease.
What type of antibiotics should be considered for chronic exacerbation treatment?
Chronic suppressive antibiotics or intravenous antibiotics with aminoglycosides and anti-pseudomonal.
What is the impact of chronic hypoxia in bronchiectasis?
Can lead to pulmonary artery hypertension and right heart overload.
What are some features of acute exacerbation in bronchiectasis?
- Change in sputum production
- Increased dyspnea
- Cough
- Fever
- Wheezing
- Reduced pulmonary function
