bronchiectasis

Question 1

what is it

Answer 1

is the permanent abnormal dilation in one or more of the lung bronchi. extra mucus is secreted and pools in the areas of the airways that are dilated making the person more prone to infection. similar symptoms to COPD but does not always show as airway obstruction

Question 2

epidemiology

Answer 2

precise incidence uncertain, female more than male,

Question 3

pathogenesis- 1 and 2 and 3

Answer 3

1- impaired mucocillary clearance leads to the accumulation of secretion
2- accumulation of secretion leads to infection by bacteria
3- infection by bacteria leads to increase mucous production, increased impaired ciliary performance, increased inflammatory response

Question 4

pathogenesis- 4 and 5

Answer 4

4- excess inflammatory response causes tissue damage
5- tissue damage eventually produces dilated bronchi including loss of ciliated epithelium and impaired mucocillary clearance- permanent- high risk, infective isolated in hospitals

Question 5

causes

Answer 5

idiopathic, infection- usually in childhood, cystic fibrosis, immunodeficiency, ciliary dysfunction, allergic bronchopulmonary aspergillosis ABPA- fungal infection, inflammatory condition, aspiration/ obstruction

Question 6

clinical features

Answer 6

virtually all patients have cough and chronic sputum production, 75% dyspnoea and wheeze, 50% chest pain- caused by cough, 1/3 have signs of chronic sinusitis and nasal polyps, recurrent exacerbations are common
approx 50% patients experience haemoptysis (rarely life threatening)- coughing up blood

Question 7

types

Answer 7

saccular (occur in large bronchi that becomes large and ballon like), cylindrical (involves medium sized bronchi which usually are symmetrically dilated), varicose (constrictions and dilations deform the bronchi), the above may be localised or widespread

Question 8

symptoms of acute exacerbations

Answer 8

changes in sputum production, increased dyspnoea, increased cough, temp 38+, increased wheezing, malaise, fatigue, lethargy or decreased exercise tolerance, reduce pulmonary function, X-ray changes consistent with new pulmonary process, changes in chest sounds

Question 9

treatments and management

Answer 9

physio- chest clearance techniques, IV/ORAL/ Nebulised antibiotics, bronchodilators, steroids, nasal sprays, flu and pneumococcal vaccinations, surgery- transplant rare

Question 10

prognosis

Answer 10

the prognosis hospital treated patients was better than for patients with COPD, but poorer of patients with asthma, associated diseased has an effect on prognosis e.g. cystic fibrosis

Question 11

conclusion

Answer 11

chronic disease requiring long term follow up, unlikely that many of the underlying causes of bronchiectasis will be eradicated in near future, emphasis placed on the need to improve the understanding of the condition and the effectiveness of treatment, ideally all patients should be reviewed by respiratory specialist