Bronchiectasis Flashcards
1
Q
Bronchiectasis Overview
A
- Abnormal dilatation of bronchi and bronchioles leading to recurrent bronchial infection and chronic cough.
- Related to chronic airway infection and inflammation resulting in airway damage.
2
Q
Clinical Features of Bronchiectasis
A
- Chronic productive cough
- Recurrent Bronchial Infection
- Purulent and intermittently bloodstained sputum
- Coarse crackles on chest ausculatation
- <5% can have fingernail clubbing
3
Q
Causes of Bronchiectasis
A
- Idiopathic predominantly
- Pneumonia in childhood.
- Cystic Fibrosis.
- Allergic Bronchopulmonary Aspergillosis
- Radiotherapy of breast cancer,
- Connective tissue disease
- Primary Ciliary dyskinesia
- alpha-1-antitrypsin deficiency
- GORD can contribute to symptoms
- Can have contributing asthma or COPD
4
Q
Investigation of Bronchiectasis
A
- High res CT Chest is gold standard for diagnosis
- Look for signet ring sign
- Pulmonary function testing showing obstruction in 34% of cases
- Consider sputum MCS including test for Mycobacterium
- No identifiable cause? Consider following tests
- Serum Total IgE, IgG, IgE to Aspergillus
- ANA, RF for autoimmune screening
- Sweat chloride test for CF
5
Q
Management of Bronchiectasis
A
- Treat underlying cause if known
- Pulmonary Rehab for airway clearance
- Action plan for infective exacerbation
- Immunisation against pneumococcal disease, COVID, Influenza
- Cessation of smoking if present contributor
- Regular exercise to maintain weight, strength and muscle mass.
6
Q
Specialist referral indicators for Bronchiectasis
A
- Rapid progression of symptoms
- Lack of response to treatment
- Pseudomonas or non-TB mycobacteria in sputum.
- Haemoptysis.
7
Q
Indications for Abx in bronchiectasis
A
- Increased sputum volume and change in sputum viscosity
- Increased sputum purulence
Increased cough with associated wheeze/breathlessness/haemoptysis.
8
Q
Antibiotic therapy for Bronciectatsis
A
Non-severe and no Pseudomonas - Amoxicillin 1g PO TDS or Doxycycline 100mg PO BD
