Bronchiectasis

Question 1

What is Bronchiectasis

Answer 1

> Permanent abnormal dilation in one or more of the lungs bronchi
Extra Mucus is then secreted + pools in dilated areas (breeding ground for infection)

*Similar symptoms to COPD but will not always present as an airway obstruction

Question 2

Epidemiology of Bronchiectasis

Answer 2

> Precise incidence = unknown
63% = female
average age = 66 yrs
average stay is almost 9 days = long stay

Question 3

Pathogenesis of Bronchiectasis

Answer 3

1. impaired mucociliary clearance (due to initial infection/inflammation)
2. Accumulation of secretions
3. Infection by bacteria
4. Increased mucus production
   Impaired ciliary performance
   Increased Inflammatory response
5. Tissue Damage
6. Dilated Bronchi
   Loss of ciliated epithelium

> Back to step 1 = vicious cycle

Question 4

Causes of Bronchiectasis

Answer 4

> Idiopathic = unknown 
Links to 
- Infection (usually in childhood + never fully recover)
- Cystic fibrosis (CF creates changes which then lead to bronchiectasis)
- Immunodeficiency
- Ciliary dysfunction
- Inflammatory conditions
- Aspiration/obstruction

Question 5

Clinical Features of bronchiectasis

Answer 5

All patients (almost)
> Cough
> Chronic sputum production

~75%
> Dyspnoea
> Wheeze

~50%
> Chest pain (usually due to chronic cough but need to rule out other causes)
> Hameoptysis (coughing up blood - not always sign of more serious pathology)

~33% (mouth breathers due to nasal blockage)
> Chronic sinusitis
> Nasal Polyps
*Therefore air is colder and dryer

*Recurring exacerbations is common (distinguishing between isolated and colonising exacerbations will aid treatment)

Question 6

Diagnosis of Bronchiectasis

Answer 6

> Chest X ray
High resolution CT - looking for airway deformation + excess mucus
Blood test (general infection markers)
Sputum microbiology
PFT (spirometry doesn’t always show as obstructive)

Question 7

Symptoms of an exacerbation of Bronchiectasis

Answer 7

> VS. Patient NORMAL (4of these = exacerbation)

• Change in sputum production
• Increased Dyspnoea
• Increased Cough
• Temp > 38 degrees
• Increased Wheezing
• Malaise
• Fatigue/decreased exercise tolerance
• Reduced pulmonary function (test after exacerbation resolves to see long term effects)
• X ray - compare to older x-rays (consistent with new pulmonary process)
• Changes in chest sounds

Question 8

Treatment/Management of Bronchiectasis

Answer 8

> Physiotherapy (aid sputum clearance)
> Antibiotics
> Bronchodilators
> Steroids
> Nasal Spray 
> Vaccinations 
> Surgery 
- drain/clear fluid 
- transplant (rare)

Question 9

Prognosis for Bronchiectasis

Answer 9

> Better than COPD
Worse than asthma
Depends on associated diseases (e.g cystic fibrosis)

> Chronic + Progressive disease that will only get worse (chest clearing techniques will help prevent exacerbations + complications)