Bronchiecstasis Flashcards
What is bronchiecstasis?
Permanent abnormal dilation in one or more of the lungs bronchi.
Extra mucus is secreted and pools in the areas of the airway that are dilated, making the person more prone to infection.
Pools of mucus = good area for bacteria to grow
Cilia is affected, therefore difficulty clearing it off the chest
Similar symptoms to COPD, but does not always show as airflow obstruction, therefore does not come up term COPD.
Epidemiology -
Precise incidence is uncertain
Prevalence, incidence and mortality have all increased over recent years
Avg stay in hospital - 8.8 days
More common in females than males
60% diagnosis are made in over 70 age group
Pathogenesis of bronchiecstasis -
Impaired mucocillary clearance leads to accumulation of secretions
Accumulation of secretions leads to infection by bacteria
Infection by bacteria leads to increase mucus production, therefore increase in impaired cillary performance and increased inflammatory response
Excessive inflammatory response causes tissue damage
Tissue damage eventually produces dilated (permanently) bronchi including loss of ciliates epithelium and impaired mucocilliary clearance
*BACK TO STEP 1 - VISCOUS CYCLE
What causes bronchiecstasis?
Idiopathic - unsure of actual cause, but can be linked to:
Infection (usually in childhood)
Cystic fibrosis - patients can have both
Immunodeficiency
Cillary dysfunction - normally will have increase mucus in airways, hub for potential bacteria growth.
Fungal infection (allergic bronchopulmonary aspergillosis -ABPA)
Inflammatory conditions
Aspiration/obstruction
Clinical features of bronchiecstais -
Virtually all patients have a cough and chronic sputum production (extremely productive wet cough)
75% dyspnoea and wheeze
50% chest pain - normally will be MSK bc of constant cough, but can also be from infection
1/3 have signs of chronic sinusitis and nasal ployps - find it difficult to breath through nose
Recurrent exacerbations are common
Approx 50% patients experience haemoptysis (coughing up blood)
Diagnosis -
Chest x ray
CT scans
High resolution computed tomography (HRCT)
Bloods and sputum microbiology
Pulmonary function tests - gives idea of lung function, but not necessarily a tool of diagnosis
What are we looking on X-ray/CT?
X-ray - areas of consolidation
CT - dilation of bronchial wall
Types of bronchiecstasis -
Saccular -
Forms cysts
Occurs in large bronchi that become large and balloon like
Most dangerous
Can be localised or widespread
Types of bronchiecstais
Cylindrical -
Involves medium sized bronchi which usually are symmetrically dilated
Least common and least concerning
Can be localised or widespread
Types of bronchiecstasis
Varicose -
Constrictions and dilations deform the bronchi
Can be localised or widespread
Symptoms of acute exacerbation -
Change in sputum production
Increased dyspnoea (SOB)
Increased cough
Temperature >38 degrees -sign of infection
Increased wheezing
Malaise, fatigue, lethargy or decreased exercise tolerance
Reduced pulmonary function
X-ray changes consistent with a new pulmonary process
Changes in chest sounds - on auscultation
*patient defined with having 4 of these is considered to have an acute exacerbation
Treatment and management -
Physio - managing chest clearance, breathing exercises, body positioning for natural clearance. Manual clearance of chest
IV/oral/nebulised antibiotics
Bronchodilators
Steroids - reduced mucus viscosity
Nasal sprays
Flu and pneumococcal vaccinations
Surgery - eg lung transplant, lobectomy (if only effecting a certain lobe)
*all help reduce exacerbations and infections
Prognosis -
Unclear, but related to lung function and presence of infection
Studies, some have concluded that prognosis is better for hospital treated patients with COPD, than hospital treated patients with asthma
Therefore, associated disease has an effect on prognosis
What can we conclude then about bronchiecstasis?
Chronic disease requiring long term follow up
Unlikely that many of the underlying causes of bronchiecstasis will be eradicated in near future
Emphasis on needing to improve understanding of condition and effectiveness of treatment
