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Year One - Respiratory System > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A

It is defined as a condition in which there is permanent bronchial dilation, secondary to chronic respiratory infection

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2
Q

Is bronchiectasis an obstructive or restrictive lung disease?

A

Obstructive

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3
Q

Describe the pathophysiology of bronchiectasis

A

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

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4
Q

What are the ten causes of bronchiectasis?

A

Recurrent Respiratory Tract Infections

Asthma

COPD

Cystic Fibrosis

Primary Ciliary Dyskinesia

Alpha-1 Antitrypsin Deficiency

Hypogammaglobulinemia

Rheumatoid Arthritis

Systemic Lupus Erythematosus

Sarcoidosis

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5
Q

What is the most common cause of bronchiectasis?

A

Recurrent respiratory tract infections

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6
Q

What are the five respiratory tract infections associated with bronchiectasis?

A

Influenza

Pertussis

Measles

TB

Allergic bronchopulmonary aspergillosis (ABPA)

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7
Q

What two primary ciliary dyskinesia classifications are associated with bronchiectasis?

A

Kartagener’s syndrome

Young syndrome

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8
Q

What are the three clinical features of Kartegener’s syndrome?

A

Bronchiectasis

Infertility

Situs inversus

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9
Q

What is situs inversus?

A

This is when the right testicle is situated lower than the left testicle

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10
Q

What are the three risk factors of bronchiectasis?

A

Female Gender

Older Age > 70

Smoker

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11
Q

What are the six clinical features associated with bronchiectasis?

A

Chronic Productive Cough

Haemoptysis

Exertional Dyspnoea

Rhinosinusitis Features

Finger Clubbing

Coarse Crepitations

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12
Q

What are three rhinosinusitis features?

A

Nasal discharge

Nasal obstruction

Facial pressure

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13
Q

What five investigations can be used to diagnose bronchiectasis?

A

Blood Tests

Sputum Culture

Spirometry

Chest X-Ray (CXR)

CT Scan

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14
Q

What two blood test results indicate bronchiectasis?

A

Increased WCC Levels

Increased CRP/ESR Levels

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15
Q

What additional blood test can be useful in diagnosing bronchiectasis? Why?

A

Autoimmune Screen (Anti-CCP, ANA, ANCA)

This can enable the underlying cause to be identified

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16
Q

How can sputum cultures be used to diagnose bronchiectasis?

A

It can be used to identify the causative organism related to infection

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17
Q

What are the four causative organisms associated with bronchiectasis?

A

Haemophilus Influenza

Pseudomonas Aeruginosa

Klebsiella Spp.

Streptococcus Pneumoniae

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18
Q

What is the most common causative organism associated with bronchiectasis?

A

Haemophilus Influenza

19
Q

What is a spirometry test?

A

It is a test that measures the volume and flow of air during exhalation and inhalation

20
Q

What three metrics are obtained from a spirometry test?

A

Forced Expiratory Volume 1 (FEV1)

Forced Vital Capacity (FVC)

FEV1 : FVC

21
Q

What is FEV1?

A

It is defined as the volume that has been exhaled at the end of the first second of forced expiration

22
Q

What is FVC?

A

It is defined as the volume that has been exhaled after a maximal expiration, following a full inspiration

23
Q

What spirometry result indicates bronchiectasis? Why does this make sense?

A

FEV1 : FVC < 70%

Bronchiectasis is an obstructive lung disease

24
Q

What are the three signs of bronchiectasis on CXR?

A

Tram Tracks

Ring Shadows

Thickened Airways

25
Q

What are tram tracks?

A

It refers to thickened parallel walls of cyclindrcal bronchiectasis

26
Q

Why is a CXR not a reliable investigation to diagnose bronchiectasis?

A

It may appear normal in mild disease

27
Q

What is the gold standard investigation used to diagnose bronchiectasis?

A

CT scan

28
Q

What is the feature of bronchiectasis on CT scans?

A

Bronchial dilation, with or without airway thickening

29
Q

In what five ways do we manage bronchiectasis conservatively?

A

Pulmonary Rehabilitation

Postural Drainage

Smoking Cessation

Annual Influenza Vaccination

One Off Pneumococcal Vaccination

30
Q

What is postural drainage?

A

It involves positioning a patient such that gravity has maximal effect of facilitating lung secretion drainage

31
Q

In what three ways can we pharmacologically manage bronchiectasis?

A

Mucoactive Agents

Long Term Antibiotics

Bronchodilators

32
Q

What two mucoactive agents are used in bronchiectasis?

A

Nebulised saline

Carbocysteine

33
Q

How are mucoactive agents used to treat bronchiectasis?

A

They aid clearance of sputum

34
Q

In which bronchiectasis patients do we administer mucoactive agents to?

A

Those who have difficulty expectorating sputum – such as the frail and elderly

35
Q

In which bronchiectasis patients do we administer long term antibiotics to?

A

Those that suffer from three or more exacerbations per year

36
Q

What is the first line antibiotic administered in bronchiectasis? How frequently?

A

Azithromycin

Three times per week

37
Q

What bronchodilator is used to manage bronchiectasis?

A

Formoterol

38
Q

In which bronchiectasis patients do we administer bronchodilators to?

A

Those with activity limiting dyspnoea

39
Q

What two surgeries are used to treat bronchiectasis?

A

Lung Resection

Lung Transplant

40
Q

In which bronchiectasis patients do we consider lung resection in?

A

Those with localised disease, in which pharmacological management has failed

41
Q

In which bronchiectasis patients do we consider lung transplant in?

A

In younger patients (<65) with rapid deterioration despite pharmacological management

42
Q

What are the four complications of bronchiectasis?

A

Respiratory Failure

Massive Haemoptysis

Anxiety

Depression

43
Q

What is the most common complication of bronchiectasis?

A

Respiratory Failure

Year One - Respiratory System (14 decks)

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