Bronchiectasis Flashcards
Bronchiectasis
What is it?
a condition where parts of the airways become enlarged, inflamed and at risk of collapsing
Bronchiectasis
What can it be induced by?
- Infection
- Impaired host immune response
- Conditions such as tracheo/bronchomalacia
- Focal airway obstruction
- Smoking
- Genetic diseases, such as cystic fibrosis and primary ciliary dyskinesia
Bronchiectasis
What are the classical clinical features?
- cough and production of purulent sputum
- dyspnea, wheezing and chest pain
- history of multiple resp infections
During acute exacerbations, sputum is more viscous and darker
Bronchiectasis
How is it diagnosed?
clinically, but confirmation of airway dilatation on a MDCT is needed
Bronchiectasis
When diagnosing, it is also important to look for potentially treatable caused/infections and the distribution at CT of bronchiectasis may be helpful.
Complete these:
* Central/perihilar involvement: ________
* Upper lobe involvement: ________
* Middle/lower lobe involvement: ________
* Lower lobe involvement: ________
Central/perihilar involvement: suggestive of allergic aspergillosis
Upper lobe involvement: suggestive of cystic fibrosis
Middle/lower lobe involvement: suggestive of primary ciliary dysfunction
Lower lobe involvement: suggestive of idiopathic bronchiectasis
Bronchiectasis
What are some investigations that are done, and why? (lab tests)
- FBC
- Immunoelectrophoresis to look for any immunodeficiencies
- Testing for cystic fibrosis (either sweat test or mutation analysis)
- Sputum culture to look for potential pathogens
Bronchiectasis
What might be seen on a CXR?
CXR
- atelectasis
- a “tram track” sign
- opacities in the periphery
(non-specific)
Bronchiectasis
What might be seen on a MDCT? When is an MDCT indicated?
MDCT:* indicated if CXR is normal or if it is abnormal and bronchiectasis is suspected*.
Airway dilatation, which confirms the diagnosis of bronchiectasis, can be seen if:
- Bronchoarterial ratio > 1
- No tapering of bronchi
- Distance from airway to costal pleural surface < 1 cm or airway touching mediastinal pleura
Bronchiectasis
How might the results of a pulmonary function test be?
spirometry:
- potentially normal , but in severe bronchiectasis, obstructive pattern is common
Bronchiectasis
What is the overall aim of management? (prescribing)
- decreasing inflammation and reducing and managing potential infections
Mucolytic agents and hydration may help patients clear secretions.
Bronchiectasis
Which ABxs do we use under these conditions?
No sputum analysis available: ____
No resistant organisms: ____ or ____
Beta-lactamase-positive organisms: ____, ____, ____ (2nd or 3rd generation), ____
Sensitive Pseudomonas: ____
Resistant Pseudomonas: ____
- No sputum analysis available: oral fluoroquinolone
- No resistant organisms: oral amoxicillin or macrolide
- Beta-lactamase-positive organisms: oral amoxicillin-clavulanate, fluoroquinolone, cephalosporin (2nd or 3rd generation), macrolide
- Sensitive Pseudomonas: oral ciprofloxacin
- Resistant Pseudomonas: hospital admission and IV administration of an appropriate antibiotic based on the sensitivity profile
Bronchiectasis
Since bronchiectasis is the result of bronchial injury from prior infections or pathologies, treatment of the causative disease is usually not possible or ineffective.
What preventative can be used to stop the progression of bronchiectasis?
- Treatment of nontuberculous mycobacteria (NTM)
- Primary immunodeficiencies: treatment with intravenous immunoglobulins (IVIG)
- Allergic bronchopulmonary aspergillosis: treatment with glucocorticoids and antifungals
Bronchiectasis
How long is the course of ABx for pt with few and recurrent exacerbations?
- Duration of therapy ranges from about 10 to 14 days for patients with few exacerbations.
- Long-term antibiotic therapy is recommended as preventative treatment if patients have recurrent exacerbations (i.e. > 2-3 per year).
Bronchiectasis
Why do we use ABx?
Treatment with antibiotics may reduce inflammation in the airways and bacterial load during an acute exacerbation.
Bronchiectasis
What is the managment? (non-prescribing)
- airway clearance therapy (bronchial hygiene)
- surgery (remove damaged lobes or control haemoptysis
- resolutive surgery -> bilateral lung transplant
- stent or tracheobronchoplasty for pt with tracheobronchomegaly
- help for pt with dysphagia or GORD may need help to avoid exacerbations
