Bronchiectasis Flashcards
What is bronchiectasis?
Chronic irreversible dilatation of one or more bronchi or bronchioles
Describe the bronchi in bronchiectasis
- irreversible dilatation
- poor mucous clearance > stagnant pools
- predisposition to chronic or recurrent bacterial infection
How does chronic inflammation cause bronchiectasis?
Inflammation causes destruction of the elastic and muscular components of the bronchial wall > irreversible dilatation
Primary cause of bronchiectasis in the western world
Congenital conditions
Causes of bronchiectasis
- whooping cough
- TB
- idiopathic
- mucociliary clearance defects: cystic fibrosis, Young’s syndrome, Kartagerner syndrome
- hypogammaglobulinaemia
- alpha 1 antitrypsin deficiency
- obstructions (foreign body, tumour)
- rheumatoid arthritis
- inhalation of toxic gases
- yellow nail syndrome
- HIV
What blood tests can be used to identify the cause in newly diagnosed bronchiectasis?
- CF genotype
- RF + anti-CCP
- auto antibodies
- alpha-1-antitrypsin level
- HIV test
- immunoglobulin levels
Common organisms that cause bronchiectasis
- haemophilus influenzae
- pseudomonas aeruginosa
- moraxella catarrhalis
- mycobacterium tuberculosis
- fungi: aspergillus, Candida albicans
What is imaging is used to investigate bronchiectasis?
high resolution CT
CXR
Classic findings in CXR of bronchiectasis
Dilated bronchi with thickened walls
(Tram track sign)
Classic finding on a CT scan of a patient with bronchiectasis
- signet ring sign: bronchial dilatation bigger than adjacent blood vessels
- bronchial wall thickening
What is the signet ring sign?
Dilated bronchus (bigger) + accompanying pulmonary artery branch (smaller)
Symptoms of bronchiectasis
- Chronic cough - most common
- daily purulent sputum production - most common
- fever
- breathlessness on exertion
- intermittent haemoptysis
- nasal symptoms
- chest pain
- fatigue
- wheeze - less common
Signs of bronchiectasis
- hypoxaemia
- fever
- haemoptysis
- fine crackles (rales)
- high pitched inspiratory squeak
- rhonchi
- history of weight loss
- peripheral oedema
- clubbing - less common
What is rhonchi?
Continuous gurgling or bubbling sounds heard during inhalation and exhalation
What is rales?
Fine crackles
Like Velcro being pulled apart
What is yellow nail syndrome?
Triad of:
- yellow fingernails
- bronchiectasis
- lymphoedema
Management of bronchiectasis
- exclude immunodeficiency/ treat identifiable cause
- physio/ daily airway clearance
- inhaled corticosteroids + bronchodilators
- low dose macrolides
- annual flu vaccine
- routine vaccinations against Haemophilus influenzae + streptococcus pneumoniae
- lung transplant
Drug management of infective exacerbations of bronchiestasis
- sputum culture needed to identify causative organism
- 10-14 days antibitoics
- amoxicillin for haemophilus influenzae
- ciprofloxacin for pseudomonas aeruginosa
What is first line treatment for exacerbation of bronchiectasis due to haemophilus influenzae?
amoxicillin 10-14 days
doxycycline if allergy
What is first line treatment for exacerbation of bronchiectasis due to Pseudomonas aeruginosa?
ciprofloxacin 10-14 days
What are low dose macrolides?
What is the mechanism of action?
Examples
- Antibiotics with anti inflammatory and antibiotic effect
- Inhibits protein synthesis 50s
- e.g. Clarithromycin + erythromycin
Outline exacerbation in bronchiectasis
A person with bronchiectasis with deterioration in 3 or more key symptoms for at least 48 hours:
- cough
- sputum volume/consistency
- sputum purulence
- breathlessness
- fatigue
- haemoptysis
What additional infections can occur with bronchiectasis?
pseudomonas aeruginosa
non-tuberculous mycobacteria
What three conditions make up Kartagener’s syndrome?
Bronchiectasis
Sinusitis
Situs inversus
What three conditions make up Young’s syndrome?
Bronchiectasis
Sinusitis
Infertility in men
How can you differentiate between COPD and bronchiectasis
- diminished breath sound only in COPD
- signet ring sign + thickened dilated airways only in bronchiectasis
- remember that patient with COPS may develop bronchiectasis
