Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Permanent dilation of the bronchi. Sputum collects and organisms grow in the wide tubes resulting in chronic cough, continuous sputum production and recurrent infections.

Question 2

What are the causes of bronchiectasis?

Answer 2

1. Post-infective: TB, measles, pertussis, pneumonia.
2. Cystic fibrosis,
3. Bronchial obstruction: lung cancer/foreign body,
4. Immune deficiency: Selective IgA or hypogammaglobinaemia.
5. Yellow nail syndrome
6. Allergic bronchopulmonary aspergillosis,
7. Ciliary dyskinetic syndrome
8. Kartagener syndrome
9. Alpha-1 antitrypsin def

Caused by infection and/or inflammation

Question 3

What are the features of bronchiectasis?

Answer 3

Persistent productive cough with large volumes of sputum.
Dyspnoea,
Haemoptysis.
Signs - coarse crackles and wheeze. Finger clubbing. Cor pulmonale

Question 4

What are the investigations for bronchiectasis?

Answer 4

Chest x ray: Tram-track opacities and ring shadows
High resolution CT: Gold standard. Airway diameter is bigger than diameter of accompanying blood vessel
Sputum culture: most common organisms are haemophilus influenza and pseudomonas aeruginosa

Question 5

What is the management of bronchiectasis?

Answer 5

Physical training (inspiratory muscle training), postural drainage, antibiotics for exacerbations, bronchodilators, immunizations, surgery

Question 6

What is a -pneumonic for the causes of bronchiectasis?

Answer 6

I CRAM.
Immune OVER-response: Allergic bronchopulmonary aspergillosis.
Immune UNDER-response: HIV, inherited immunodeficiencies.
Congenital - Cystic fibrosis, primaru ciliary dyskinesia, yellow nail syndrome.
Childhood infections - TB, measles, pertussis
Respiratory disease - COPD, pulmonary fibrosis.
Aspiration pneumonia
Mechanical obstruction

Question 7

what is the treatment for pseudomonas aeruginosa?

Answer 7

Ciprofloxacin

Question 8

What is yellow nail syndrome?

Answer 8

Characterized by yellow fingernails, bronchiectasis and lymphoedema