Bronchiectasis

Question 1

Define bronchiectasis

Answer 1

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

Question 2

Aetiology of bronchiectasis

2

Answer 2

Chronic lung inflammation leads to fibrosis & permanent dilation of bronchi
Leads to pooling of mucus —> predisposed to further cycles of infection, damage & fibrosis of bronchial walls

Question 3

Causes of bronchiectasis

6

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

Epidemiology of bronchiectasis

age, incidence x2

Answer 4

Most often arises in CHILDHOOD
Incidence has decreased w/ use of antibiotics
1/1000 per year

Question 5

Presenting symptoms of bronchiectasis

7

Answer 5

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

Question 6

Signs of bronchiectasis on physical examination

3

Answer 6

Clubbing
Course crepitations (usually at lung bases)
shift w/ coughing
Wheeze

Question 7

Investigations for bronchiectasis

5

Answer 7

Sputum
CXR
High resolution CT
Bronchography
Others

Question 8

Investigations for bronchiectasis - sputum

2

Answer 8

Culture & sensitivity

Common organisms
pseudomonas aeruginosa
haemophilus influenzae
staphylococcus aureus
streptococcus pneumoniae
klebsiella
mycobacteria

Question 9

Investigations for bronchiectasis - CXR

5

Answer 9

Dilated bronchi - may be seen as parallel lines going through hilum to diaphragm (tramline shadows)
Fibrosis
Atelectasis
Pneumonic consolidations
May be NORMAL

Question 10

Investigations for bronchiectasis - high resolution CT

2

Answer 10

BEST DIAGNOSTIC METHOD

Shows dilated bronchi w/ thickened walls

Question 11

Investigations for bronchiectasis - bronchography

Answer 11

rarely used

Question 12

Investigations for bronchiectasis - others

Answer 12

sweat electrolytes (for cystic fibrosis)
serum Ig
mucociliary clearance study

Question 13

Management of bronchiectasis

9

Answer 13

Treat acute exacerbations w/ TWO IV ANTIBIOTICS which cover Pseudomonas aeruginosa
Prophylactic antibiotics should be considered in patients w/ frequent exacerbations (>3 per yr)
Inhaled corticosteroids (e.g. fluticasone) reduce inflammation & volume of sputum but do NOT affect frequency of exacerbation or lung function
Bronchodilators - considered in patients w/ responsive disease
Maintain hydration
Flu vaccination
Physiotherapy - enables sputum & mucus clearance, can reduce frequency of acute exacerbations & aid recovery
Bronchial artery embolisation - if life threatening haemoptysis due to bronchiectasis
Surgical - localised resection, lung or heart transplant

Question 14

Complications of bronchiectasis

6

Answer 14

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

Question 15

Prognosis for bronchiectasis

Answer 15

Most patients continue to have symptoms for 10 years