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General med - Resp > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

When should you suspected bronchiectasis in adults

A

Persistent production of mucopurulent sputum

Persistent cough(> 8 weeks)

Rheumatoid arthritis if symptoms of chronic productive cough or recurrent chest infections

COPD with frequent exacerbations

Poorly controlled asthma

IBD and chronic productive cough

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2
Q

Clinical features of bronchiectasis

A 
Large volumes of purulent sputum 
Dyspnoea 
Fever 
Fatigue 
Haemoptysis that can be frank 
Weight loss 
Chest pain
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3
Q

What might you find on examination in an individual with bronchiectasis

A 
Coarse crackles, especially in lower lung zones 
Wheeze 
High-pitched inspiratory squeaks 
Large airway rhonchi 
Palpable chest secretions on coughing 
Finger clubbing
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4
Q

What is bronchiectasis

A

Is a permanent dilatation and thickening of the airways, characterised by chronic cough, excessive sputum production, bacterial colonisation and recurrent acute infections

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5
Q

Bronchiectasis aetiology

A 
Cystic fibrosis 
Post-infection(childhood respiratory viral infections)
Immunodeficiency(HIV) 
Connective tissue diseases(RA) 
Asthma 
Immotile ciliary syndrome
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6
Q

Appropriate investigations for bronchiectasis

A 
Sputum culture 
CXR 
Spirometry 
Oxygen sats levels 
FBC
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7
Q

Investigations for bronchiectasis in secondary care

A

High-resolution computed tomography(HRCT)

Testing for cystic fibrosis(sweat chloride or gene testing)

Screening for gross antibody deficiency

Serum total immunoglobulin IgE and specific IgE or skin prick test to aspergillus

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8
Q

Which patients with bronchiectasis should be followed up in secondary care

A

3 or more exacerbations in a year
Chronic pseudomonas aeruginosa, MRSA, or non-TB colonisation
Deteriorating bronchiectasis with declining lung function or advanced disease
Allergic pulmonary aspergillosis
Associated RA, immunodeficiency, IBDetc

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9
Q

Gold standard radiological investigation for diagnosis of bronchiectasis

A

High resolution CT of the chest

Very high sensitivity and specificity for diagnosis

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10
Q

HRCT features of bronchiectasis

A

Bronchial wall dilation

Bronchial wall thickening

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11
Q

Why is it necessary to obtain respiratory tract specimens in patients with bronchiectasis

A

To maximise chances of isolating H.influenzae and S.pneumoniae

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12
Q

What does persistent isolation of S.aureus(or P.aeruginosa in children) indicate

A

Possible underlying bronchopulmonary aspergillosis or cystic fibrosis

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13
Q

How should patients be tested for aspergillus fumigatus and aspergillosis precipitins

A

Serum IgE, skin prick testing or serum IgE testing

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14
Q

Use of gastrointestinal investigations in bronchiectasis

A

Low threshold for GI investigations in children

Gastric aspiration should be considered in patients following lung transplantation

24-hour pH monitoring for those suspected of having bronchiectasis secondary to gastrointestinal reflux or aspiration

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15
Q

When should suspected bronchiectasis be tested for primary ciliary dyskinesia

A

For children where no other cause for bronchiectasis is identified and if there is a history of continuous rhinitis, neonatal respiratory distress, and/or dextrocardia; and for adults if there is a history of upper respiratory tract problems or otitis media

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16
Q

Use of bronchoscopy in bronchiectasis

A

Indicated when bronchiectasis affects a single lobe, to exclude a foreign body

In adults with localised disease, it may be indicated to exclude proximal obstruction

17
Q

Features of general management in bronchiectasis

A

Healthy diet and physical exercise

Smoking cessation(passive smoking should also be avoided)

Immunisation against influenza and pneumococcus

18
Q

When should a person with an infective exacerbation of bronchiectasis be admitted to hospital

A 
Significant co-morbidities and/or psychosocial factors 
Cyanosis 
Confusion 
SOB, rapid resp
Peripheral oedema 
Temperature of 38 degrees or higher
19
Q

Management of bronchiectasis when hospital admission is not required

A

Reassess and rule out other differentials
Sputum culture
Antibiotic for 7-14 days
Suitable airway clearance technique by resp physiotherapist
Offer trial of long-acting bronchodilator therapy if significant breathlessness

20
Q

Which antibiotic treatment is suitable in acute exacerbation of bronchiectasis

A

If microbiology cultures are not available, prescribe amoxicillin

Alternative choice oral antibiotics if at high risk of treatment failure are co-amoxiclav or levofloxacin

21
Q

Preventative measures for acute exacerbations of bronchiectasis

A

People with bronchiectasis who have three or move exacerbations per year(azithromycin)

22
Q

What is the first-line therapy in brochiectasis patients with concurrent pseudomonas aeruginosa infection

A

Inhaled colistin

23
Q

What should be investigated before commencing prophylactic oral macrolides

A

Perform ECG to assess QTc interval

Perform baseline LFTs

Counsel about potential adverse effects, including gastrointestinal upset, hearing and balance disturbance, cardiac effects, and microbiological resistance

24
Q

Which medication can be used prior to treatment to enhance sputum clearance

A

Inhaled beta-2 agonists

25
Q

Non-pharmacological interventions for bronchiectasis

A

Physiotherapy - airway clearance techniques and exercise

Non-invasive ventilation of intermittent positive pressure breathing

Pulmonary rehabilitation

Sterile water inhalation

26
Q

Surgical options for management of bronchiectasis

A

Lung resection surgery in patients with localised disease

Bronchial artery embolisation and/or surgery are first-line therapy for management of massive haemoptysis

Lung transplantation may need to be considered for end-stage disease if pulmonary function is very poor with FEV1 below 30% of predicted

27
Q

Complications of bronchiectasis

A

Repeated infection and deteriorating lung function

Empyema

Lung abscess

Pneumothorax

Life-threatening haemoptysis

Respiratory failure

Right heart failure secondary to chronic respiratory disease

Amyloidosis

28
Q

Conditions which cause decreased mucociliary clearance and should therefore be tested for

A

Cystic fibrosis
Kartagener’s
HIV
Immunoglobulin deficiency

29
Q

Which vaccination reduces incidence of bronchiectasis

A

Pertussis vaccine

30
Q

Complications of bronchiectasis

A

Recurrent infections
Life threatening haemoptysis
Cor pulmonale

31
Q

What is pyemia

A

Septic focus or embolus in the blood stream

32
Q

What is empyema

A

Presence of pus in the pleural cavity

33
Q

Lobes of lung usually affected by bronchiectasis

A

Lower lobes

34
Q

Types of bronchiectasis

A

Tubular
Cylindrical
Varicose
Cystic

35
Q

Microscopic findings in bronchiectasis

A

Bronchial atresia

Inflammatory cells and inflammatory debris

36
Q

Lung function test findings in bronchiectasis

A

Obstructive pattern - low FEV1/FVC ratio

37
Q

CXR findings in bronchiectasis

A

Usually nonspecific
Might show some filtrates ‘tram-tracking’ dilation of airways
Crowded bronchial markings extending to the periphery

General med - Resp (11 decks)

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