BRONCHIECSTASIS

Question 1

Define bronchiecstasis

Answer 1

Lung airway disease characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections

Question 2

Aetiology of bronchiecstasis

Answer 2

Chronic lung inflammation leads to fibrosis and permanent dilation of the bronchi
This leads to pooling of mucus, which predisposes to further CYCLES of infection, damage
and fibrosis of bronchial walls

Question 3

Causes of bronchiecstasis

Answer 3

Idiopathic (50%)
Post-infectious (e.g. pneumonia, whooping cough, TB)
Host-defence defects (e.g. Kartagener’s syndrome, cystic fibrosis)
Obstruction of bronchi (e.g. foreign body, enlarged lymph nodes)
GORD
Inflammatory disorders (e.g. rheumatoid arthritis)

Question 4

Summarise the epidemiology of bronchiectasis

Answer 4

Most often arises initially in CHILDHOOD

Incidence has decreased with the use of antibiotics 1/1000 per year

Question 5

Recognise the presenting symptoms of bronchiectasis

Answer 5

Productive cough with purulent sputum or haemoptysis
Breathlessness
Chest pain
Malaise
Fever
Weight loss
Symptoms usually begin AFTER an acute respiratory illness

Question 6

Recognise the signs of bronchiectasis on physical examination

Answer 6

Clubbing
Coarse crepitations (usually at lung bases) - These shift with coughing
Wheeze

Question 7

LIST 4 appropriate investigations for bronchiectasis

Answer 7

Sputum cultures and sensitivity
CXR
High-Resolution CT
Bronchography

Question 8

Findings on CXR for bronchiecstasis

Answer 8

Dilated bronchi (may be seen as parallel lines going
from the hilum to the diaphragm (tramline
shadows))**BUZZ
Fibrosis
Atelectasis
Pneumonic consolidations

May be NORMAL

Question 9

Which is the best diagnostic method for bronchiecstasis?

Answer 9

High-Resolution CT

Question 10

Findings on CT for bronchiecstasis

Answer 10

Dilated bronchi with thickened walls

Question 11

Generate a management plan for bronchiectasis

Answer 11

Treat acute exacerbations with TWO IV ANTIBIOTICS, which cover Pseudomonas aeruginosa

Prophylactic antibiotics should be considered in patients with frequent exacerbations (> 3/year)

Inhaled Corticosteroids (e.g. fluticasone) - reduces inflammation and volume of sputum but does NOT affect the frequency of exacerbations or lung function

Bronchodilators - considered in patients with responsive disease

Maintain hydration

Flu vaccination

Physiotherapy -enables sputum and mucus clearance. This can reduce frequency of
acute exacerbations and aid recovery

Bronchial artery embolisation - if life-threatening haemoptysis due to bronchiectasis

Surgical - localised resection, lung or heart-lung transplantation

Question 12

Which organisms are commonly found in sputum cultures of bronchiecstasis?

Answer 12

Pseudomonas aeruginosa 
Haemophilus influenzae 
Staphylococcus aureus  
Streptococcus pneumoniae 
Klebsiella 
Mycobacteria

Question 13

Identify the possible complications of bronchiectasis

Answer 13

Life-threatening haemoptysis   
Persistent infections  
Empyema   
Respiratory failure  
Cor pulmonale   
Multi-organ abscesses

Question 14

Summarise the prognosis for patients with bronchiectasis

Answer 14

Most patients continue to have symptoms after 10 years