Bronchiectasis Flashcards
What is bronchiectasis?
Permanent dilation of bronchi
What is the pathogenesis of bronchiectasis?
Inflammation and destruction of the bronchial wall
Dilated airways cause accumulation of purulent secretion, impairing gas exchange and causing airway obstruction
Impaired clearance increases incidence of infection
What is the typical patient with bronchiectasis?
Recurrent ‘chest infections’
Recurrent antibiotic prescriptions
No or short lived response to antibiotics
What are causes of bronchiectasis?
Idiopathic (50%) Pulmonary infections (pneumonia, TB) Cystic fibrosis Immunodeficiency Connective tissue disorders Chronic obstruction (tumour, nodes, foreign body) Young's disorders Kartanager's syndrome Allergic bronchopulmonary aspergillosis Rheumatoid arthritis Pulmonary fibrosis
What is chronic bronchial sepsis/persistent bacterial bronchitis?
When a patient has all the hallmarks of bronchiectasis but no bronchiectasis on HRCT
Confirmed positive sputum results
Often younger patients, women, childcare
Older with COPD or airway disease
What are the symptoms of bronchiectasis - both chronically and in an exacerbation?
Persistent productive cough Breathlessness Haemoptysus and blood-tinged sputum Fatigue Chronic pleuritic chest pain In exacerbation: - worsening of cough - change in sputum colour - increase in sputum volume - fever
What are examination signs of bronchiectasis?
Fever Crackles High-pitched inspiratory squeaks Rhonchi Wheezing Hypoxaemia
What investigation is used to diagnose bronchiectasis?
High resolution CT
What signs on CT show bronchiectasis?
Dilation of bronchi Thickening of bronchial walls Lack of tapering of airways Tram track airways Signet ring sign - bronchus is wider than accompanying pulmonary artery Tree in bud pattern
What investigations are done for bronchiectasis to determine cause?
FBC, U&Es, LFT IgG/M/A Functional antibodies Sputum cultures - standard and mycobacterial Spirometry Aspergillus IgG/IgE and total IgE Testing for cystic fibrosis Vasculitis and CTD screen
What is the general management for bronchiectasis?
Stop smoking
Flu vaccine
Pneumococcal vaccine
What is the pharmacological management for bronchiectasis in an exacerbation?
Send sputum sample
Give 14 days antibiotics appropriate to most recent positive culture
Alter antibiotics if culture shows resistant organisms
Inhaled bronchodilator
Mucolytic
What is the pharmacological management for bronchiectasis when colonised with persistent bacteria?
Oral macrolide antibiotic
Nebulised gentamicin, colomycin
Pulsed IV antibiotics
What is the long term pharmacological management for bronchiectasis?
Low dose macrolide antibiotics - clarithromycin or azithromycin
Not very effective in current smokers
