Bronchiectasis

Question 1

what is bronchiectasis

Answer 1

irreversible abnormal dilation of one or more bronchi, with chronic airway inflammation.

associated with chronic sputum production, recurrent chest infections and airflow obstruction.

Question 2

bronchiectasis pathophysiology

Answer 2

1. Initial insult e.g. infection damages the airways.
2. Disordered anatomy leads to 2° bacterial colonization, perpetuating inflammatory change and damaging the mucociliary escalator.
3. This prevents bacterial clearance and leads to further airway damage. Major airways and bronchioles are involved, with mucosal oedema, inflammation, and ulceration.
4. Terminal bronchioles become obstructed with secretions, leading to volume loss.
5. A chronic host inflammatory response ensues, with free radical formation and production of neutrophil elastase, further contributing to inflammation.
6. Bronchial neovascularization, with hypertrophy and tortuosity of the bronchial arteries (which are at systemic pressure), may lead to intermittent haemoptysis.

Question 3

bronchiectasis causes

Answer 3

1. usually idiopathic
2. cystic fibrosis
3. infection, immunodeficiency, airway diseases, toxic and mechanical insults, associated diseases e.g. rheumatoid, sle, ibd.

Question 4

clinical features

Answer 4

1. recurrent chest infections
2. confirmed with hrct

Question 5

investigations

Answer 5

1. cxr - ring shadows and tramlines, indicating thickened airways and the gloved finger appearance
2. hrct
3. spirometry with reversibility testing
4. sputum mc&s
5. immunoglobulins A, M, G
6. RAST for aspergillus, IgE
7. CFTR mutation screen and sweat test

Question 6

Mx

Answer 6

1. treat underlying condition
2. airway clearance by daily physiotherapy via
   • active cycle of breathing technique
   • postural or autogenic drainage
   • cough augmentation
   • exercise regimes
   • nebulised saline or hypertonic saline
     - reduction of bacterial load and prevention of 2° airway inflammation and damage with antimicrobial chemotherapy
     - lung transplant

Question 7

antimicrobial chemotherapy

Answer 7

• Patients need a higher antibiotic dose and for a longer time period (usually 10–14 d) than people without bronchiectasis

-Treatment response is usually assessed by a fall in sputum volume and change to mucoid from purulent or mucopurulent sputum, with an improvement in systemic symptoms, spirometry, and C-reactive protein (CRP)

-Pseudomonas-colonized patients have more frequent exacerbations, worse CT scan appearances, and a faster decline in lung function.

Question 8

How to identify bronchiectasis exacerbations

Answer 8

An exacerbation is usually a clinical diagnosis, with an increase in sputum volume and tenacity and with discoloration. It may be associated with chest pain, haemoptysis and wheeze, and systemic upset—fevers, lethargy, and anorexia.