Bronchiectasis

Question 1

what is bronchiectasis? what are some reasons for its development?

Answer 1

a persistant, irreversible dialation of the airways with injury to the airway wall

• result of chronic infection (TB) or inflammation (CF)

Question 2

what is the vicious cycle hypothesis? for bronchiectisis

Answer 2

• people might be pre-disposted to developing robust inflammatory response to an infection or injury
• this robust response damages walls, cilia, etc.
• results in mucus stasis and airway abnormality (dilation)
• the statsis leads to increased risk of infection
• cycle continues

Question 3

etiology of bronchectasis
(focal & diffuse)
- categories within diffuse

Answer 3

Focal
- obstruction (FB, aspiration)

Diffuse
- infection (TB most common) pneumonia, mycobacterial
- immunodeficiency –> CF, allergic bronchopulmonary aspergilliosis, A1A, primary cilliary dyskinesai
- autoimmune (RA, sjorens)
- idiopathic
-

Question 4

signs adn symptoms of bronchectasis

Answer 4

symptoms
- chronic cough
- recurrecnt respiratory infections
- increased sputum production LOTS and FOUL SMELLING AND PURULENT
- SOB, chest pain, hemoptysis (erroded capillaries)

signs
- crackles
- wheezing
- rhonchi
- digital clubbing

Question 5

Diagnosis of bronchiectasis
- gold standard
- additional tests

Answer 5

gold standard = high resolution CT
- going to see dilated airways (lower MC)
- signet sign (bronchi bigger than artery abnormal
- airways visable when 1cm from pleural shouldnt see them

• CXR
• labs (CBC, IGG, CF testing, sputum for bacteria)
• PFT: reduced FEV1 and FEV1/FEV ration

Question 6

what are some findings of CXR you would see in bronchiectasis?

Answer 6

• tram-track apperance of the airway
• irregualr peripheral opacities (mucopurulnet rings or “plugging”

Question 7

Direct treatment of bronchiectasis

Answer 7

• tret underlying condtion
• infection: antimicrobials
• surgical resection of lung if necessary
• CF: CF drugs
• ABPA: steroids + antifungal
• Immnodef.: immunoglobin

Question 8

since bronchiectasis is a lifelong condition, what are some management strageties?

Answer 8

• treat exacerbations
• control the chronic (chronic azithromycin)
• reduce inflammation (steroids for acute exacerbations)
• improve bronchohygeine (PEP device or vest in CF to clear mucus)

** up to date immunizations, physiotherapy, bronchodialtors as needed**