bronchiectasis

Question 1

what is bronchiectasis and what is it generally caused by

Answer 1

irreversible and abnormal dilation of the bronchial tree

generally caused by cycles of bronchial inflammation in addition to mucus plugging and progressive airway destruction

Question 2

describe the aetiology of bronchiectasis

Answer 2

CF- most common cause in developed countries

bronchial narrowing/ obstruction - COPD, aspriration, tumours, ABPA

severe or chronic lung infection e.g. pneumonia or TB

immunodeficiency

Question 3

what proportion of bronchiectasis cases are idiopathic

Answer 3

50%

Question 4

describe the pathophysiology of bronchiectasis

Answer 4

excessive inflammatory response to infection or obstruction which leads to fibrosis

airway dilates as surrounding tissue contracts

dilation leads to stasis of mucus -> chronic infection

Question 5

what are the most common strains of bacteria involved in bronchiectasis

Answer 5

haemophilus influenzae
pseudomonas aeruginosa

Question 6

outline the clinical signs of bronchiectasis

Answer 6

clubbing
recurrent chest infections
coarse crackles on auscultation
reduced/ absent breath sounds in areas distal to those of obstruction

Question 7

what are the investigations used in bronchiectasis

Answer 7

HRCT chest
bloods: FBC, U&Es, LFT, IgG/M/A, functional antibodies, aspergillus IgG/ IgE and total IgE
standard and mycobacterial cultures

Question 8

outline the management in bronchiectasis

Answer 8

treat underlying cause

physiotherapy - airway clearence techniques

antibiotics for acute exacerbation

consider long term antibiotics in frequent exacerbations