Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Abnormal dilation of bronchi due to destruction of elastic and muscular components of bronchial wall. Thickening of bronchi also occurs.

Often consequence of recurrent and/ severe infections or secondary to underlying dis.

Question 2

Pathophysiology of bronchiectasis?

Answer 2

Chronic inflamm due to pathogens in airways→ bronchial wall oedema and increased mucus prod.

Inflamm cells (inclu neutrophils, T lymphocytes, etc) recruited to airways→ release inflamm cytokines, proteases, and reactive oxygen mediators→ progressive destruction of airways.

Question 3

Primary causes of bronchiectasis? (Aetiology)

Answer 3

Infection (TB, bacterial pneumonia; childhood viral RT infections inclu measles, influenza, etc)

Immunodeficiency (immunoglobulin def, HIV)

Chronic aspiration (i.e: GORD)

Chronic inflamm

Question 4

Secondary causes of bronchiectasis? (Aetiology)

Answer 4

Underlying lung cond (asthma, COPD, etc)

Connective tissue disorder (RA, etc)

Congenital dis (CF, primary ciliary dyskinesia)

Question 5

Kartagener’s triad for primary ciliary dyskinesia?

Answer 5

Situs inversus, bronchiectasis and chronic sinusitis

Question 6

Signs and symptoms of bronchiectasis?

Answer 6

Cough w sputum (green; brown)
Crackles and high-pitched inspiratory squeaks
Dyspnoea
Fever (esp w acute exacerbation)
Finger clubbing
Wheeze
Fatigue, haemoptysis, rhinosinusitis, weight loss

Question 7

Investigations for bronchiectasis?

Answer 7

Obs and bloods
- FBC: WCC determine if infection/ exacerbation. If eosinophils elevated→ possible underlying allergic bronchopulmonary aspergillosis.

High resolution CT: cross-section→ bronchi larger than adjacent pulmonary artery (signet ring sign)

Sputum culture and sensitivity: bacterial and fungi cultures recommended for all patients

CXR: non-specific and non-diagnostic but may show obscured hemidiaphragm/ thin-walled ring shadows/ tram lines/ opacities

Question 8

Management for initial presentation of bronchiectasis?

Answer 8

All conservative

• Improved nutrition and exercise
• Smoking cessation
• Chest physio/ “Airway clearance therapy”

Question 9

Management for acute exacerbations of bronchiectasis?

Answer 9

Ciprofloxacin/ other ABs

Question 10

Flare-up prophylaxis for bronchiectasis? (Management)

Answer 10

• Azithromycin
• Vaccinations

Question 11

Potential complications of bronchiectasis?

Answer 11

• Recurrent infections
• Cor pulmonale