Bronchiectasis

Question 1

What is bronchiectasis? What causes the disease process?

Answer 1

• Degradation of bronchioles leading to permanent dilation and thinning of the airways
• cilia are destroyed leading to impaired mucus clearance
• Leads to saccular or fusiform airway

Causes:

• idiopathic
• post-infective I.e. pneumonia/whooping cough
• mechanical bronchial obstruction i.e. tumour/foreign body
• poor muco-ciliary clearance i.e. CF/PCD (primary ciliary dyskinesia)

Question 2

What signs and symptoms might you expect to see in someone with bronchiectasis?

Answer 2

Persistent chronic cough
Excessive purulent sputum (i.e. contains pus) over months-years
Intermittent haemoptysis
Chronic rhinosinusitis

Finger clubbing
Coarse late inspiratory crepitations
Potentially wheeze

Question 3

How would you investigation someone with suspected bronchiectasis?

Answer 3

FBC + CRP= signs of infection 
Sputum culture= signs of infection i.e. prone to pseudonomas infection 
CXR
-cystic shadows 
-thickened bronchiole walls= tramlines
CT
-signet ring is a diagnostic sign
I.e. dilated bronchiole with adjacent artery leads to signet ring appearance 

Spirometry= shows obstructive pattern

CF sweat test if suspected

Question 4

How would you manage chronic bronchiectasis?

Answer 4

Methods to clear sputum:

• physiotherapy
• mucolytics to loosen sputum= saline nebs or carbocisteine
• ensure adequate hydration
• prophylactic antibiotics if sputum culture indicates bacterial infection

Bronchodilators if got associated asthma or COPD

Steroids for ABPA (allergic bronchopulmonary aspergillosis)

Question 5

What is important ask about the sputum in bronchiectasis? Why does this occur?

Answer 5

Need to ask about the amount that was produced

• bronchiectasis is associated with very large amounts of sputum production that is consistent throughout the day
• important to differentiated from
• sacular alveoli and widened airways lead to collection of sputum

Question 6

What is the different between bronchiectasis and bronchitis?

Answer 6

Bronchiectasis= widening and scarring of airways

Bronchitis= inflammation and narrowing of small and large airways

Question 7

What breathing technique can be used to help patients with bronchiectasis? Why does it help?

Answer 7

Pursed-lip breathing
-positive pressure acts during expiration to keep the airways open during exhalation

Use:

• helps to prevent the alveolar from collapse during exhalation due to the positive pressure
• helps to combat “air-trapping” by removing CO2 which might be trapped in lungs to prevent hypercapnia

Question 8

How can you differentiate between chronic bronchitis and bronchiectasis?

Answer 8

Clinically present the same but difference in the structure of airways

Bronchiectasis= saccular or fusiform alveoli

Bronchitis= cylindrical

Question 9

How can you differentiate between bronchiectasis and COPD?

Answer 9

HX:

• significant smoking HX with COPD
• recurrent infection associate with bronchiectasis
• increased sputum production throughout the day in bronchiectasis but tends to be more in the morning with COPD

Question 10

What is the pathophysiological circle of bronchiectasis?

Answer 10

• Inflammation causes damage and destruction of cilia, elastic and muscular tissue
• reduced mucociliary clearance due to damaged mucociliary escalator
• excessive mucus production
• damage to bronchioles
• microbials colonise the mucus and lead to infection

Consequences:

• recurrent infection
• permenant dilation of bronchi

Question 11

What are signs of acute exacerbation of bronchiectasis and how would you treat it?

Answer 11

Deterioration and worsening of baseline symptoms over 48 hrs with associated breathlessness and haemoptysis

2 week course of antibiotics
-prolonged course due to damaged lung parenchyma

Oxygen as required

Question 12

What microbe needs to ruled out or treated in bronchiectasis and why?

Answer 12

Pseudomonas

-associated with increased rate of hospital admissions and increased frequency of exacerbations