Bronchiectasis

Question 1

Bronchiectasis: What is it?

Answer 1

Bronchiectasis= permanentdilationof thebronchi due to damage to the airways. This causes sputum and pathogen accumulation and makes the lungs susceptible to infection. It is a type of COPD

Question 2

Bronchiectasis: Aetiology

Answer 2

Caused by damaged airways:
- Idiopathic (no apparent cause)
- Pneumonia
- Tuberculosis
- Alpha-1-antitrypsin deficiency
- Connective tissue disorders (e.g., rheumatoid arthritis)
- Whooping cough (pertussis)
- Cystic fibrosis
- Yellow nail syndrome: characterised by yellow fingernails, bronchiectasis and lymphoedema. Patients are stable and have good clinical signs

Question 3

Bronchiectasis: Symptoms

Answer 3

• Shortness of breath
• Chronic productive cough
• Recurrent chest infections
• Weight loss

Question 4

Bronchiectasis: Examination signs

Answer 4

• 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 5

Bronchiectasis: Investigations

Answer 5

Sputum cultureis used to identify colonising and infective organisms. The most common infective organisms are:

• Haemophilus influenza
• Pseudomonas aeruginosa

Chest x-ray findings include:

• Tram-track opacities(parallel markings of a side-view of the dilated airway)
• Ring shadows(dilated airways seen end-on)

High-resolution CT(HRCT) is the test of choice for establishing the diagnosis.

Question 6

Bronchiectasis: Management

Answer 6

• Vaccines(e.g., pneumococcal and influenza)
• Respiratory physiotherapyto help clear sputum
• Pulmonary rehabilitation
• Long-term antibiotics(e.g., azithromycin) for frequent exacerbations (e.g., 3 or more per year)
• Inhaled colistinforPseudomonas aeruginosacolonisation
• Long-acting bronchodilatorsmay be considered for breathlessness
• Long-term oxygen therapyin patients with reduced oxygen saturation
• Surgical lung resectionmay be considered for specific areas of disease
• Lung transplantis an option for end-stage disease

Infective exacerbationsrequire:

• Sputum culture(before antibiotics)
• Extended courses of antibiotics, usually 7–14 days
• Ciprofloxacinis the usual choice for exacerbations caused byPseudomonas aeruginosa

Answer 7

The key features to remember with bronchiectasis are finger clubbing, diagnosis by HRCT, Pseudomonas colonisation and extended courses of 7-14 days of antibiotics for exacerbations.