Bronchiectasis

Question 1

Aetiology

Answer 1

CF
Bronchial obstruction (if 1 lobe)
Kartanager’s syndrome (organs opposite sides)
ABPA allergic bronchopulmonary aspergillosis
Immunodeficiency
50% idiopathic

Question 2

What is bronchiectasis

Answer 2

Irreversible & abnormal dilation of bronchial tree caused by cycles of bronchial inflammation, also mucus plugging & airway obstruction progressively

Question 3

Pathophysiology of bronchiectasis

Answer 3

Excessive inflammatory response to infection or obstruction leading to fibrosis
Airways dilate as scar tissue contracts allowing mucus stasis = chronic infection

Question 4

Most common strains of bacteria in bronchiectasis

Answer 4

Haemophilus influenzae
Pseudomonas aeruginosa

Question 5

Symptoms & signs

Answer 5

Chronic productive cough, fever, malaise & flecks of haemoptysis

Clubbing, recurrent infections, coarse crackles & reduced sounds distal to obstruction

Question 6

Investigations

Answer 6

High resolution CT = thickened, dilated airways
FBC, U&E and LFT
Antibody tests & IgM

Question 7

Treatments

Answer 7

Treat underlying cause- Smoking cessation or give antibodies/ flu vaccines
airway clearance techniques
Antibiotics for acute exacerbations
Consider long-term antibiotics in frequent exacerbators

Question 8

What antibiotics are used to treat bronchiectasis

Answer 8

Oral macrolide is 1st line
Nebulised gentamicin, colomycin, tobramycin

Question 9

How to treat acute exacerbation

Answer 9

Appropriate abx for last sputum sample -14 days
Alter antibiotics if sputum shows resistance