Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Chronic inflammation of the lung causing permanent dilatation of airways and thickening.

The chronic inflammation also causes squamous cell metaplasia and loss of cilia.

Question 2

Describe the typical presentation of patients with bronchiectasis?

Answer 2

May present with non specific pulmonary symptoms:
Chronic cough with large quantity of purulennt sputum production.
Recurrent LRTI or febrile episodes
Dyspnoea
Chest Pain
Haemoptysis- intermittent
Halitosis

Question 3

What are the causes of bronchiectasis?

Answer 3

Idiopathic

Congenital:
-Cystic Fibrosis
Primary Cillary Dyskinesia (immotile cillia syndrome)

Acquired:

• Most commonly occurs post inf: Tb, Pneumonia, Measles, RSV.
• Following recurrent aspiration pneumonias.
• Allergic Bronchopulmonary Aspergillosis (ABPA)
• Foreign body
• Connective tissue disorders e.g. RA

Note: smoking independently is not a risk factor (differs to COPD)

Question 4

What are the physical signs of bronchiectasis?

Answer 4

Productive cough worse in the morning as the sputum production from the night has not been cleared.

Coarse Crackles are present in 70% usually bilateral

Large airway ronchi (snoring sound)

Wheeze

Clubbing

May be signs of LRTI

COPD:
Less sputum production
No clubbing

Question 5

What investigations would you do in suspected bronchiectasis?

Answer 5

Bloods:
FBC (infection)
Immune testing if suspected

Microbiology:
Sputum culture

Imaging:
CXR- cystic shadowing
High resolution CT- signet ring appearance

Invasive:
Bronchoscopy may be indicated if the bronchiectasis affects a single lobe this is to rule out a foreign body,

CF sweat test

Question 6

How is bronchiectasis managed?

Answer 6

Smoking cessation (although it is not an independent risk factor, it is more likely to predispose to infection)

Immunisations: Influenza and pneumococcus

Physiotherapy: to be taught the airway clearance techniques

Mucolytics: carbocisteine.

Immunisations
Bronchodilators can help

Surgery if only affecting one lobe

Question 7

How should LRTI in patients with bronchiectasis be treated?

Answer 7

Patients should be educated to recognise signs and symptoms of LRTI and should be given antibiotics to start empirically.

1st line:
Amoxicillin 500 mg tds for 14days

If penicillin allergic Clarithromycin 500mg bd should be used.

In patients that are colonised with pseudomonas (this often indicates worsening disease) Ciprofloxacin should be used.