Bronchiectasis

Question 1

What is bronchiectasis

Answer 1

permanent dilation and destruction of bronchi caused by
1. repeated infection.
2. obstruction/impaired drainage.
3, defective host response

Question 2

What is the MRC dyspnoea scale

Answer 2

1. SOB on exercise
2. SOB slight hill
3. SOB on walking flat compared to peers
4. SOB 100m on flat/ few mins
5. SOB at rest

Question 3

Signs on bronchiectasis on examination

Answer 3

Depends on cause.
Yellow nails/ CTD signs/ vasculitis rash/ PICC line/ cachexia/ Clubbing
copious secretions

Question 4

Respiratory causes of clubbing

Answer 4

Asbestosis
Bronchiectasis
Cystic fibrosis
Dirty tumours (squamous cell/ adenocarcinoma/ mesothelioma)
Empyema

Question 5

Causes of bronchiectasis?

Answer 5

Infection: HIV/ Whooping cough/ TB/ Measels/ repeated aspiration
Obstruction: Foreign body
Autoimmune; ABPA/ hypogammaglobulinaemia / CTD. RA
Idiopathic
Neoplastic: tumour obstruction of airway
Congenital: yellow nail syndrome/ CF/ Youngs syndrome/ Kartagener’s syndrome

Question 6

Complications of bronchiectasis

Answer 6

Haemoptysis
Cor pulmonale
Infections
Empyema
Amyloidosis
Anaemia
Cerebral abscess

Question 7

Investigations into bronchiectasis

Answer 7

Bedside spirometry
Bloods (immunoglobulins/ HIV/ RAST/ aspergillus serology/ Autoantibodies)
Microbiology: sputum culture/ AFB/ cytology
XR chest
CT scan
Lung function tests (obstructive)

Question 8

What do you look for on XR chest for bronchiectasis?

Answer 8

Tramlines and ring shadows
Mucus plugging
Hyperinflation
Honeycomb pattern

Question 9

What do you look for on CT chest?

Answer 9

Dilated airways >1.5 to accompanying pulmonary artery
Bronchial thickening
mucus plugging
obliterative bronchiolitis

Question 10

If CF what specific investigations?

Answer 10

Genetic testing
immunoreactive trypsinogen
Sweat test (CL>60mM)

Question 11

If Kartagener’s syndrome what is the specific test?

Answer 11

Saccharine ciliary motility test

Question 12

Non pharmacological management of bronchiectasis

Answer 12

Smoking cessation
Exercise
Healthy diet
chest physiotherapy
enhanced breathing techniques
dietician input

Question 13

Pharmacological management of bronchiectasis

Answer 13

Depend son causes but broadly
- mucolytics
- rescue antibiotics (azithromycin)
- bronchodilators
- inhaler corticosteroids
- nebulisers

Question 14

Surgical management of bronchiectasis

Answer 14

Localised resection
Lobectomy
pneumonectomy
in CF bilateral lung transplant