Bronchiectasis

Question 1

Epidemiology of bronchiectasis ?

Answer 1

Females
most diagnoses over 70

Question 2

Pathophys of bronchiectasis ?

Answer 2

occurs after airway damage

damage = persistent bacterial colonisation = chronic inflammation

permanent dilation of bronchi and mucus plugging = reduced bacterial clearance

Question 3

What is yellow nail syndrome?

Answer 3

Yellow finger nails
bronchiectasis
lymphedema

Question 4

What could cause damage to airway that could cause bronchiectasis?

Answer 4

Idiopathic (no apparent cause)
Pneumonia
Whooping cough (pertussis)
Tuberculosis
Alpha-1-antitrypsin deficiency
Connective tissue disorders (e.g., rheumatoid arthritis)
Cystic fibrosis
Yellow nail syndrome

Question 5

Presentation of bronchiectasis?

Answer 5

Productive and persistent cough (mucus)

Dyspnoea
chest pain
haemoptysis
recurrent chest infections
weight loss

Question 6

Signs of bronchiectasis on examination?

Answer 6

Sputum pot by the bedside
Oxygen therapy (if needed)
Weight loss (cachexia)

Finger clubbing

Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
Scattered crackles throughout the chest that change or clear with coughing
Scattered wheezes and squeaks

Question 7

Investigation of bronchiectasis?

Answer 7

aim to find underlying cause

Sputum culture
CXR
HRCT

Question 8

What common organisms found in sputum for bronchiectasis?

Answer 8

Haemophilus influenza
Pseudomonas aeruginosa

Question 9

What is often found on CXR for bronchiectasis?

Answer 9

Tram-track opacities (parallel markings of a side-view of the dilated airway)

Ring shadows (dilated airways seen end-on)

Question 10

Management of bronchiectasis?

Answer 10

Vaccines (e.g., pneumococcal and influenza)

Respiratory physiotherapy to help clear sputum

Pulmonary rehabilitation

Long-term antibiotics (e.g., azithromycin) for frequent exacerbations (e.g., 3 or more per year)

Inhaled colistin for Pseudomonas aeruginosa colonisation

Long-acting bronchodilators may be considered for breathlessness

Long-term oxygen therapy in patients with reduced oxygen saturation

Surgical lung resection may be considered for specific areas of disease

Lung transplant is an option for end-stage disease

Question 11

Management for infective exacaerbations?

Answer 11

Sputum culture (before abx)
Extended courses of antibiotics, usually 7–14 days
Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa

Question 12

What abx to use for infective exaccerbation of bronchiectasis of Pseudomonas aeruginosa

Answer 12

ciprofloxacin