Bronchiectasis Flashcards
What is bronchiectasis?
The localised, irreversible dilation and damage of the bronchial tree
The involved bronchi become dilated, inflamed and are easily collapsible, with impaired clearance of secretions, causing mucus pooling in the lungs
What are the 3 types of bronchiectasis?
Cystic - Dilated bronchi form clusters of cysts
Tubular - Bronchi are dilated and cylindrical
Varicose - Bronchi are irregular with areas of dilatation and constriction
What are some common symptoms and presentations of bronchiectasis?
Recurrent chest infections
Recurrent antibiotic prescriptions
Wheezing
Shortness of breath
Coughing
Foul smelling mucus
Digital clubbing
How is bronchiectasis usually diagnosed?
High Resolution CT scanning
This will usually show a “cygnet ring” appearance, where the bronchiole can be seen to be a large black ring, next to a much smaller arteriole, the stone
What are some other tests that may be carried out in bronchiectasis?
Pulmonary function testing will show a decreased lung capacity and decreased FEV1 due to decreased lung elasticity
Finally, genetic testing can be carried out in cases of cystic fibrosis and primary colliery dyskinesia
How does bronchiectasis occur?
Chronic inflammatory of the bronchioles leads to a build up of elastases in the bronchial wall
These break down elastin and causes dilation and cytokine production, causing an increase in mucus production
Dilatation and the input of the aetiology causes a breakdown of the mucocilliary escalator, so excess mucus cannot be cleared
What are some of the consequences of bronchiectasis?
Hypoxia, causing vasoconstriction of the pulmonary arterioles
This increases pulmonary vascular resistance and thus pressure, which can eventually lead to right sided heart failure and hypertrophy, known as cor pulmonale
What are some conditions that can cause bronchiectasis?
Infection (usually childhood)
Bronchial obstruction
Primary cilliary dyskinesia
Cystic fibrosis
Young’s syndrome
Kartagener’s syndrome
Allergic Broncho-Pulmonary Aspergillosis
Immunodeficiency
Rheumatoid arthritis
Bronchopulmonary sequestration
Mounier-khun syndrome
Yellow-Nail syndrome
Pulmonary fibrosis
What are some childhood infections that can lead to bronchiectasis?
Severe pneumonia
Whooping cough
Tuberculosis
Measles
Pseudomonas aeruginosa
Aspergillus fumigatus
What is primary ciliary dyskinesia?
It is a congenital disorder, leading to a deficiency in the proteins required for cilia motility
This causes a breakdown of the mucociliary escalator, so mucus in not cleared from the lungs, therefore increasing the risk of pneumonia and infection
How can cystic fibrosis lead to bronchiectasis?
The thickening of mucus causes blockages in the bronchioles, increasing the risk of infection and causing dilation of the bronchioles
What is Young’s syndrome?
A condition usually found in young people
It is characterised by bronchiectasis, chronic sinusitis and azoospermia, which is the functional blockage of the epididymis
What is kartagener’s syndrome?
A condition, similar to Young;s syndrome, characterised by bronchiectasis, chronic sinusitis and situs inversus (Swapping sides of some organs)
It is an autosomal recessive ciliary disorder
What is meant by SPUR in finding immunodeficiency disorders?
Severe
Persistent
Unusual
Recurrent
What is bronchopulmonary sequestration?
A condition in which a piece of the lung is supplied directly from the aorta, so it doesn’t form properly
This causes bronchodilator of other bronchi, to increase air supply
What is Mounier-khun syndrome?
A possible autosomal recessive disorder that leads to enlargement and dilatation of respiratory tract
There are 3 subtypes
What is Yellow-Nail syndrome?
A condition characterised by yellow, thickened nails, pulmonary effusions, bronchiectasis and lymphedema
How can pulmonary fibrosis cause bronchiectasis?
Scarring of the lungs causes contraction of lungs, pulling open the airways and dilating the bronchioles
What is Chronic bronchial sepsis (Persistent bacterial bronchitis)?
Chronic bronchial infection resulting in the daily production of purulent sputum
Despite the name, it does not commonly cause sepsis
It has all of the hallmarks of brocnhiectasis, but shows no signs of bronchiectasis on CT
Who is more at risk of chronic bronchial sepsis?
Often younger patients, mainly women involved in childcare, or in older patients with COPD who smoke
What are some investigations that can be performed in cases of bronchiectasis?
Full Blood Count
Urea and Electrolytes
Lung Function Tests
IgG/M/A
Functional anti-bodies
Aspergillus IgG/IgE and total IgE
Standard and mycobacterial cultures
Vasculitis screening and CTD screening
How can bronchiectasis be managed?
Treatment consists of long term management and treatment of exacerbations:
- Stopping smoking
- Flu and covid vaccines
- Pneumococcal vaccines
-Reactive antibiotics
How are reactive antibiotics given?
Sputum cultures are taken
Antibiotics are given, appropriate to the last sputum cultures taken
14 days of antibiotics
How is colonisation treated in bronchiectasis?
Repeated sputum cultures are taken
Give low dose macrolide antibiotics:
- Clarithromycin 250mg OD
- Azithromycin 250mg 3x per week
Give nebulised gentamicin, colomycin or tobramycin
Give pulsed IV antibiotics
