Bronchiectasis Flashcards
Define bronchiectasis
Chronic inflammatory and destructive airway disease, leading to permanent destruction/ secondary dilation and thickening of mucosal walls.
What is the typical history in bronchiectasis?**
History of initial insult such as lung infections aka whooping cough in childhood.
Progressively worse breathlessness
With a productive cough - copious amounts of clear/purulent sputum.
What is the basic pathophysiology underlying bronchiectasis?
History of initial lung injury e.g CF or whooping cough
Area of airway damage and inflammation
Dilated section of airway - increased mucus production - defect in mucociliary clearance - leads to accumulation of mucus
Environment prone to infection
Inflammation and further bronchial wall dilation and thickening, oedema and inc mucous production.
Ongoing progressive airway disease/cycle ‘vicious cycle hypothesis’
Reduces the surface area for gaseous exchange leading to breathlessness.
What are the core presentations in bronchiectasis?
Chronic progressive shortness of breath 8w+
Persistent productive cough - clear phlegm outside of exacerbation 8w+
Recurrent infections
What are the most common causes of bronchiectasis?
Idiopathic
Previous pulmonary pathology - commonly pertussis (whooping cough) and pneumonia
Underlying immunological conditions (inc risk of infection)
Aspergillosis (fungal RTI)
Cystic fibrosis (excess secretion of thick mucus makes the airway prone to infection)
Connective tissue disorders
Yellow nail syndrome
What are patients with bronchiectasis at risk of?
Atypical infections
e.g psuedomonas
What investigations should be ordered for a patient with suspected bronchiectasis?
Bedside - obs (RR, O2sats, temp), ECG, sputum sample for culture and sensitivity
Bloods - blood cultures, FBC (wcc, Hb, Hematocrit), CRP, ESR, U&Es
Imaging - CXR, high res contrast CT
Others - spirometry, bronchoscopy
What can be seen on a CXR of bronchiectasis?
Tramlines - side one
Ring lesions - front on
Respresent dilated and thickened bronchial walls.
What is the golden standard imaging technique for diagnosis bronchiectasis?
What is shown on this image technique?
High Res contrast CT
Dilated bronchi - lack of tapering
Thicked bronchial walls
Signet ring sign - when dilated bronchi and accompanying pulmonary artery are seen in cross section - bronchus is markedly dialted >1:
Bronchi visible within 1cm of pleural surface
Bunch of grapes sign
What conservative management should be used for bronchiectasis?
Annual vaccination
Chest physio/Pulmonary rehab - airway clearing techniques such as breathing technique, postural drainage and manual techniques
Community Nurses
Smoking cessation
Patient education
What medical management should be used for bronchiectasis?
Specialist respiratory input
Prophylactic antibiotics
Salbutamol inhaler
Carbocysteine
What signs and symptoms might a person with bronchiectasis have?
Shortness of breath 8w
Chronic productive cough 8w
Recurrent chest infections
Weight loss
Finger clubbing
Cor pulmonale (raised JVP and peripheral oedema)
Scattered crackles throughout the chest that change or clear with coughing
May have pleuritic chest pain
Scattered wheezes and squeaks.
Rhinosinusitis symptoms - 65-75%
GORD
How does yellow nail syndrome present?
Yellow fingers nails
Bronchiectasis
Lymphoedema
Stable with good clinical signs
How does bronchiectasis present on respiratory examination?
May be on oxygen, and may have sputum pot
Check - yellow nail syndrome, clubbing (uncommon)
Auscultation - scattered wheeze and fine inspiratory crackles.
Palpable chest secretion of cough
Large airway rhonchi
Tend to be female and non smokers.
What features of bronchiectasis can suggest a undiagnosed CF as underlying aetiology?
Early onset (norm onset at 70yrs)
Male infertility
History of malabsroption
Childhood steatorrhea
What are the three morphological types of bronchiectasis?
Tubular/cylindrical - most common - smooth uniform dilation of bronchi with loss or norm tapering - signet ring sign and tram-track sign as parallel bronchial walls
Varicose - uncommon, irregular bronchiole dilation, interspered areasof constriction
Cystic - associated with CF, dilate bronchi cyst like and filled with air or fluid.
