Bronchiectasis

Question 1

What is bronchiectasis

Answer 1

Airway widening - permanent dilation of subsegmental airways

Question 2

Initial insult of bronchiectasis (e.g. trigger factors)

Answer 2

congenital- cystic fibrosis, primary ciliary dyskinesias
Infective- HIV, TB and common respiratory bacteria

Obstructive- COPD, tumours, foreign bodies, irritants, allergic broncho-pulmonary aspergillosis

Other- idiopathic, tertiary

Question 3

Formation pathway of bronchiectasis

Answer 3

Bacterial infection and colonisation 
Neutrophil inflammation
Airway destruction and distortion
Abnormal mucus clearance (stasis)
Leads to more bacterial infection and colonisation

Question 4

Consequences of bronchiectasis

Answer 4

SOB
Fatigue
Cupfuls of sputum, sometimes with blood
Recurrent pneumonias (colonised bacteria multiplies)
Pleural effusions (inflammatory transudate accumulated)
secondary pneumothorax (parenchyma damages lung lining)
Haemoptysis (larger vessels eroded by chronic disease)
RHF (increases pulmonary resistance)

rarely: cerebral abscess or amyloidosis

Question 5

Typica; history of bronchiectasis

Answer 5

Unwell and SOB
Wet, productive cough and noticed blood in the sputum
Sputum produced in cough
Admitted to hospital years ago with severe viral pneumonia

Question 6

Atypical presentations

Answer 6

Idiopathic bronchiectasis
Dry bronchiectasis (no cupfuls of sputum)
COPD-bronchiectasis overlap

Question 7

How to diagnose COPD vs bronchiectasis

Answer 7

COPD is a functional/physiological diagnosis, Due to poor reversible airflow obstruction

Bronchiectasis is a structural diagnosis (presence of airway dilation on CT)

Question 8

ON examination

Answer 8

Acute- Ronchi, Mid inspiratory squeaks, coarse crackles

Chronic- Generalised wheezing, clubbing, RHF (raised JVP, oedema)

Question 9

Investigations

Answer 9

FBC, U&E, CRP, coagulation

Sputum M?B: causative or propagating organism (treat with broad spectrum initially, target once known)

CXR: pneumonia, effusion or bronchial thickening, fluid levels

Pulmonary function tests: obstructive picture (FEV1/FVC <0.7)

No peak flow

Question 10

Investigations to confirm

Answer 10

High resolution CT

Bronchospy- useful if culture -ve or no sputum

IF in ITU- broncho-alveolar lavage

Special tests to find primary cause: immunoglobulins, functional antibodies, aspergillum serology