Bronchiectasis Flashcards
What is bronchiectasis?
It is defined as a condition in which there is permanent bronchial dilation, secondary to chronic respiratory infection
Is bronchiectasis an obstructive or restrictive lung disease?
Obstructive
Describe the pathophysiology of bronchiectasis
In bronchiectasis, an initial respiratory infection results in the recruitment of immune cells to the bronchi, which secrete cytokines and proteases that lead to inflammation
This inflammation results in damage to the muscle and elastin contained within the bronchi walls, thus leading to bronchial dilatation
This bronchial dilatation is usually reversible following resolution of the initial infection
However, in bronchiectasis patients there is impaired mucociliary clearance which prevent this
This dilation results in an accumulation of mucus within the bronchi, predisposing to persistent microbial colonisation.
Therefore, bronchiectasis patients undergo a viscous cycle, whereby their airways are colonised by micro-organism, which increases bronchial inflammation, worsening bronchiectasis, leading to increased susceptibility to airway colonisation
What are the ten causes of bronchiectasis?
Recurrent Respiratory Tract Infections
Asthma
COPD
Cystic Fibrosis
Primary Ciliary Dyskinesia
Alpha-1 Antitrypsin Deficiency
Hypogammaglobulinemia
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Sarcoidosis
What is the most common cause of bronchiectasis?
Recurrent respiratory tract infections
What are the five respiratory tract infections associated with bronchiectasis?
Influenza
Pertussis
Measles
TB
Allergic bronchopulmonary aspergillosis (ABPA)
What two primary ciliary dyskinesia classifications are associated with bronchiectasis?
Kartagener’s syndrome
Young syndrome
What are the three clinical features of Kartegener’s syndrome?
Bronchiectasis
Infertility
Situs inversus
What is situs inversus?
This is when the right testicle is situated lower than the left testicle
What are the three risk factors of bronchiectasis?
Female Gender
Older Age > 70
Smoker
What are the six clinical features associated with bronchiectasis?
Chronic Productive Cough
Haemoptysis
Exertional Dyspnoea
Rhinosinusitis Features
Finger Clubbing
Coarse Crepitations
What are three rhinosinusitis features?
Nasal discharge
Nasal obstruction
Facial pressure
What five investigations can be used to diagnose bronchiectasis?
Blood Tests
Sputum Culture
Spirometry
Chest X-Ray (CXR)
CT Scan
What two blood test results indicate bronchiectasis?
Increased WCC Levels
Increased CRP/ESR Levels
What additional blood test can be useful in diagnosing bronchiectasis? Why?
Autoimmune Screen (Anti-CCP, ANA, ANCA)
This can enable the underlying cause to be identified
How can sputum cultures be used to diagnose bronchiectasis?
It can be used to identify the causative organism related to infection
What are the four causative organisms associated with bronchiectasis?
Haemophilus Influenza
Pseudomonas Aeruginosa
Klebsiella Spp.
Streptococcus Pneumoniae
What is the most common causative organism associated with bronchiectasis?
Haemophilus Influenza
What is a spirometry test?
It is a test that measures the volume and flow of air during exhalation and inhalation
What three metrics are obtained from a spirometry test?
Forced Expiratory Volume 1 (FEV1)
Forced Vital Capacity (FVC)
FEV1 : FVC
What is FEV1?
It is defined as the volume that has been exhaled at the end of the first second of forced expiration
What is FVC?
It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration
What spirometry result indicates bronchiectasis? Why does this make sense?
FEV1 : FVC < 70%
Bronchiectasis is an obstructive lung disease
What are the three signs of bronchiectasis on CXR?
Tram Tracks
Ring Shadows
Thickened Airways
What are tram tracks?
It refers to thickened parallel walls of cyclindrcal bronchiectasis
Why is a CXR not a reliable investigation to diagnose bronchiectasis?
It may appear normal in mild disease
What is the gold standard investigation used to diagnose bronchiectasis?
CT scan
What is the feature of bronchiectasis on CT scans?
Bronchial dilation, with or without airway thickening
In what five ways do we manage bronchiectasis conservatively?
Pulmonary Rehabilitation
Postural Drainage
Smoking Cessation
Annual Influenza Vaccination
One Off Pneumococcal Vaccination
What is postural drainage?
It involves positioning a patient such that gravity has maximal effect of facilitating lung secretion drainage
In what three ways can we pharmacologically manage bronchiectasis?
Mucoactive Agents
Long Term Antibiotics
Bronchodilators
What two mucoactive agents are used in bronchiectasis?
Nebulised saline
Carbocysteine
How are mucoactive agents used to treat bronchiectasis?
They aid clearance of sputum
In which bronchiectasis patients do we administer mucoactive agents to?
Those who have difficulty expectorating sputum – such as the frail and elderly
In which bronchiectasis patients do we administer long term antibiotics to?
Those that suffer from three or more exacerbations per year
What is the first line antibiotic administered in bronchiectasis? How frequently?
Azithromycin
Three times per week
What bronchodilator is used to manage bronchiectasis?
Formoterol
In which bronchiectasis patients do we administer bronchodilators to?
Those with activity limiting dyspnoea
What two surgeries are used to treat bronchiectasis?
Lung Resection
Lung Transplant
In which bronchiectasis patients do we consider lung resection in?
Those with localised disease, in which pharmacological management has failed
In which bronchiectasis patients do we consider lung transplant in?
In younger patients (<65) with rapid deterioration despite pharmacological management
What are the four complications of bronchiectasis?
Respiratory Failure
Massive Haemoptysis
Anxiety
Depression
What is the most common complication of bronchiectasis?
Respiratory Failure
