Bronchiectasis

Question 1

what is bronchiectasis

Answer 1

lung condition characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections

Question 2

aetiology/ causes of bronchiectasis

Answer 2

Chronic lung inflammation leads to fibrosis and permanent dilation of the bronchi

This leads to pooling of mucus, which predisposes to further cycles of infection, damage and fibrosis of bronchial walls

Question 3

causes of bronchiectasis

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

Answer 4

most common among childhood

incidence decreases with the use of antibiotics

Question 5

presenting symptoms

Answer 5

productive cough with purulent sputum or haemoptysis,

breathlessness,

chest pain,

malaise,

fever,

weight loss,

cough

Question 6

signs of bronchiectasis

Answer 6

clubbing, coarse crepitations at lung bases on inspiration, wheezing

Question 7

investigations for bronchiectasis

Answer 7

sputum (culture and sensitivity),

CXR,

high resolution CT of chest,

FBC

Question 8

common causative organisms of bronchiectasis/ lung infections secondary to bronchiectasis

Answer 8

Pseudomonas aeruginosa

Haemophilus influenzae

Staphylococcus aureus

Streptococcus pneumoniae

Klebsiella

Mycobacteria

Question 9

management of bronchiectasis

Answer 9

Treat acute exacerbations with TWO IV ANTIBIOTICS, which cover Pseudomonas aeruginosa

Prophylactic antibiotics should be considered in patients with frequent exacerbations (> 3/year)

Inhaled Corticosteroids (e.g. fluticasone) - reduces inflammation and volume of sputum but does NOT affect the frequency of exacerbations or lung function

Bronchodilators - considered in patients with responsive disease

Maintain hydration

Flu vaccination

Physiotherapy - enables sputum and mucus clearance. This can reduce frequency of acute exacerbations and aid recovery

Bronchial artery embolisation - if life-threatening haemoptysis due to bronchiectasis

Surgical - localised resection, lung or heart-lung transplantation

Question 10

prognosis

Answer 10

possible complications include; haemoptysis, persistent infections, respiratory failure, cor pulmonale

most people still have symptoms after 10 years