Bronchiectasis Flashcards
Definition
Bronchiectasis is permanent dilation of the bronchi and bronchioles due to chronic infection.
What main organisms cause this infection?
The main organisms patients are infected by include:
Haemophilius Influenzae
Pseudomonas aeruginosa
Streptococcus Pneumoniae
Staphylococcus aureus.
Causes
Post-Infection: Tuberculosis; HIV; Measles; Pertussis; Pneumonia
Bronchial Pathology: Obstruction by foreign body or tumour
Allergic Bronchopulmonary aspergillosis (ABPA)
Congenital: Cystic fibrosis; Kartagener’s syndrome; Primary ciliary dyskinesia; Young syndrome
Hypogammaglobulinaemia
Idiopathic
Presentation
Symptoms
Productive Cough
Large amounts of purulent sputum
Haemoptysis
Signs
Finger clubbing
Coarse inspiratory crepitations
Dyspneoa
Wheeze
Investigations
Spirometry: bronchiectasis has an obstructive pattern of disease. Additionally, it allows clinicians to assess the reversibility of the disease and severity
Sputum culture: to identify pathogens and guide management with antibiotics.
Chest X-ray: thickened bronchial walls, and cystic appearance, otherwise known as tramline and ring shadows
High-resolution CT: This is the best diagnostic investigation of bronchiectasis. It is monitoring the severity of the condition and can guide management.
Bronchoscopy: This allows clinicians to locate areas of obstruction, haemoptysis or sample tissue for culture.
Other investigations for cause
Serum immunoglobulins – Hypogammaglobulinaemia
Cystic fibrosis sweat test – Cystic Fibrosis
Aspergillus precipitins or skin prick test – ABPA
Rheumatoid Factor or ANA – rheumatoid arthritis
Conservative Management
Patient Education
Support Group
Chest Physiotherapy – Postural drainage at least twice daily to aid mucous drainage
Smoking Cessation
Medical Management
Antibiotics – according to local guidelines, and bacterial sensitivities. Patient with recurrent exacerbations may require long term antibiotic treatment
Bronchodilators – Including salbutamol can be given to patients with symptoms of dyspneoa and wheeze such as COPD, ABPA, asthma
Corticosteroid - Prednisolone is used in ABPA treatment
Carbocysteine - Mucolytic which reduces the viscosity of sputum
Surgical Management
Surgical excision of localized area of disease or cessation of haemoptysis.
Lung transplant may be indicated in certain patients
