Bronchiectasis

Question 1

What is Bronchiectasis?

Answer 1

• Bronchiectasis is the abnormal dilation of the airways with associated destruction of the bronchial tissue

Question 2

What is the Pathophysiology of Bronchiectasis?

Answer 2

• There is an inflammatory response to a severe infection which leads to structural damage within the bronchial walls which causes dilation
• Scarring reduces the number of cilia within the bronchi which predisposes the individual to further infections

Question 3

What are the common infectious organisms which cause bronchial damage and bronchiectasis?

Answer 3

• Haemophilus Influenzae, Streptococcus Pneumoniae and Moraxella Catarrhalis

Question 4

What are the causes of non-CF Bronchiectasis?

Answer 4

-Post-infectious
- Immunodeficiency (immunogammaglobulinaemia, IgA/IgG deficiency, HIV, Ataxia telangiectasia)
- Primary Ciliary Dyskinesia (PCD) - Autosomal Recessive condition which leads to reduced efficacy/ complete inaction of the bronchial cilia
- Post-obstructive (Foreign Body Aspiration)
- Congenital Syndromes: Young’s Syndrome: (Bronchiectasis, Reduced fertility and Rhinosinusitis) and Yellow Nail Syndrome (pleural effusions, lymphoedema and dystrophic nails )

Question 5

What are some of the Signs and Symptoms?

Answer 5

• Chronic, productive cough
• Purulent Sputum Expectoration
• Chest Pain
• Wheeze
• Breathlessness on exertion
• Haemoptysis
• Recurrent or Persistent infections of the lower respiratory tract
• finger clubbing, Inspiratory crackles, wheezing on auscultation

Question 6

What are the Investigations for Bronchiectasis - Imaging?

Answer 6

• Gold Standard: High Resolution CT, bronchial wall thickening, diameter of the bronchus is larger than the bronchial artery (signet ring sign)
• different patterns on CT: - Bilateral Upper Lobe Bronchiectasis is commoner in CF, Unilateral Upper Lobe Bronchiectasis is commoner in post-TB infection, Focal Bronchiectasis (foreign body inhalation)
• CXR - bronchial wall thickening/ airway dilatation

Question 7

What are the other Investigations for Bronchiectasis?:

Answer 7

• Bronchoscopy - Focal bronchiectasis (foreign body inhalation)/ evidence of a possibly airway abnormality
• Investigating the underlying cause - A chloride sweat test/ CFTR gene mutation analysis, FBC with leucocyte differentials, Immunoglobulin panel (immunoglobulin deficiency)
• Microbiological Assessment - Indication to the underlying cause, chronic Pseudomonas spp
• Lung Function - Spirometry (obstructive or mixed obstructive/restrictive)

Question 8

What is the Managment for Bronchiectasis?

Answer 8

• Chest Physiotherapy
• Antibiotics dependant on infectious organism
• Bronchodilators for Wheeze
• Follow-Up for monitoring and lung function

Question 9

What are the Complications of Bronchiectasis?

Answer 9

• Pneumothorax
• Poor growth and development
• Infection (recurrent)
• Life-threatening haemoptysis
• Lung Abscess