Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

A chronic and irreversible dilation of the bronchi due to chronic infection.
Characterised by having multiple pneumonias, increased mucous production and haemoptysis.

Question 2

What type of lung disease is bronchiectasis?

Answer 2

OBSTRUCTIVE

Question 3

what is the pathophysiology which leads to bronchiectasis?

Answer 3

Cause - leading to increased pneumonias/infections - inflammation - increased mucous production and dilatation - elastic fibres replaced by collagen fibres - increased obstructiveness.

Question 4

what are the causes of bronchiectasis?

Answer 4

Cystic fibrosis
Aspergillosis
Primary ciliary dyskinesia
Airway obstruction - tumour or food

Post infection - TB, pneumonia, HIV.

Question 5

What is the pathophysiology which leads to cor pulmonale?

Answer 5

Chronic bronchitis - loss of elastin - replaced by collagen - stiffer lungs - cannot perform as well - chronic hypoxia - vasoconstriction of blood vessels - pulmonary hypertension - right sided heart failure (cor pulmonale)

Question 6

What are the signs and symptoms of bronchiectasis?

Answer 6

Wheeze
Productive Cough
Purulent sputum
Haemoptysis
Recurrent infections 
Dyspnoea 
Digital clubbing
Coarse inspiratory crepitations

Question 7

What causes finger clubbing?

Answer 7

Chronic hypoxia

Question 8

What tests can be done?

Answer 8

CT
Genetic testing 
Bronchoscopy (if obstructed)
Spirometry
Sputum culture 
Chest x-ray

Question 9

What is the management of bronchiectasis?

Answer 9

Chest physio - percussion and postural drainage 2x daily
Smoking cessation
Antibiotics - may require long term
Surgery
Carbocysteine - reduces viscosity of sputum

Question 10

What treatment is used in bronchopulmonary aspergillosis?

Answer 10

Inhaled corticosteroids - an immune hypersensitivity response which results in more inflammation