Bronchiectasis

Question 1

What is bronchiectasis

Answer 1

recurrent episodes of infection, chronic cough with purulent sputum and bacterial infection secondary to irreversible dilatation of the airways

Question 2

What are the causes of bronchiectasis

Answer 2

Post infective- TB, measles pertussis, pneumonia

cystic fibrosis

bronchial obstruction - lung cancer/foreign body

immune deficiency - selective IgA ,

allergic bronchopulmonary aspergillosis

ciliary dyskinetic syndromes

yellow nail syndrome

young syndrome

Question 3

What are the most common organisms isolated from patients with bronchiectasis

Answer 3

Haemophilus influenzae ( most common )

Pseudomonas aeruginosa

Klebsiella spp

Streptococcus pneumoniae

Question 4

What may someone with bronchiectasis present with

Answer 4

persistent productive cough- purulent sputum

coarse crackles, high pitched inspiratory squeaks and pops

wheeze

dyspnoea on exertion

haemoptysis

clubbing

Question 5

What are the risk factors of bronchiectasis

Answer 5

cystic fibrosis
host immunodeficiency
previous infection
congenital disorder of bronchi
primary ciliary dyskinesia

Question 6

What are 1st investigations to order

Answer 6

High resolution chest CT-GOLD STANDARD

CXR
-parallel line opacification, indicate dilated bronchi

• spirometry

-bloods
-sputum MC&S
-test for risk factors
Alpha 1 antitrypsin
Rheumatoid factor
Immunoglobulins

Question 7

What is stepwise management of non-CF bronchiectasis

Answer 7

Airway clearance

assess response to beta-2-agonists and anticholinergic bronchodilator therapy
oxygen therapy can be considered

start empirical antibiotic therapy including inhaled antibiotics while awaiting sputum microbiology

poor response - consider lung surgery