Bronchiectasis

Question 1

Definition

Answer 1

Chronic disease = permanent dilation of the airways secondary to chronic infection of inflammation.
Due to the destruction of the elastic and muscular component of the bronchial wall

Question 2

Epidemiology

Answer 2

Female
Prevalence increases with age

Question 3

Risk factors

Answer 3

Smoking
Genetic factors

Question 4

Aetiology

Answer 4

Post infection = TB, measles, pneumonia, whooping cough
Congenital = CF, Primary ciliary dyskinesia, Kartagener’s syndrome
Allergic and inflammatory = RA, Sjogren’s, ABPA, IBD
Immunodeficiency = Hypogammaglobulinemia

Question 5

Pathophysiology

Answer 5

Chronic bronchial inflammation caused by previous infection(s) or systemic inflammatory conditions. Proteases + other mediators activated by the inflammatory response = loss of elastin + muscle = dilatation of bronchi.
Increased risk of microbial colonisation = perpetuates inflammation = increased mucus secretion and mucus trapping.
Due to the dilation and obstruction of the airways = OBSTRUCTIVE PATTERN on spirometry.
Due to bacterial colonisation, exacerbations of bronchiectasis can occur.

Question 6

Organisms most commonly associated with bronchiectasis

Answer 6

Haemophilus influenzae (most commonly),
Pseudomonas aeruginosa,
Klebsiella spp.
Streptococcus pneumoniae.

Question 7

Signs

Answer 7

Auscultation
- Coarse crackles during inspiration
- High pitched inspiratory squeaks
- Rhonchi (low-pitched snore-like sound) caused by the movement of secretions in the airway
Clubbing

Question 8

Symptoms

Answer 8

SOB
Productive cough
Copious sputum production (Khaki coloured)
Haemoptysis
Foul smelling mucus
Wheezing

Question 9

Typical presentation

Answer 9

Female patient with smoking history:
- Large amounts of khaki coloured sputum
- Haemoptysis
- Wt loss

Question 10

Diagnosis

Answer 10

FIRST LINE = CXR
- dilated airways
- thickened wall appear as ‘tram tracks’
GOLD STANDARD = High res CT chest
- bronchial dilation
- bronchial wall thickening = SIGNET RING SIGN
Sputum culture
FBC = eosinophilia suggests ABPA

Question 11

Treatment

Answer 11

FIRST LINE =
- Treat underlying cause
- Chest physiotherapy
- Annual influenza vax
- Abx = for acute exacerbations
SECOND LINE =
- Mucoactive agent (e.g. carbocisteine) = reduce sputum viscosity
- Bronchodilator = SALBUTAMOL
- Nebulised isotonic or hypertonic saline
- Long term Abx = Macrolide (Azithromycin) 3+ exacerbations, nebulised anti-pseudomonal Abx = e.g. Colistin if 3+ exacerbations AND grown pseudomonas aeruginosa
- Long term O2 therapy
- Surgery = lung transplant