Bronchiectasis Flashcards
What is bronchiectasis?
Obstructive airway disease characterised by permanent dilation (enlargement) of the bronchi
Bronchiectasis can lead to chronic cough and sputum production.
What is the peak incidence age for bronchiectasis?
Individuals over 65 years old
However, bronchiectasis can occur at any age.
Is bronchiectasis more common in men or women?
More common in women
This trend is observed in epidemiological studies.
Name a bacterial cause of bronchiectasis.
Pneumonia due to bordetella pertussis
Other bacterial causes include staphylococcus, haemophilus influenzae, and klebsiella.
What viral infections can lead to bronchiectasis?
Adenovirus, influenza, measles
These viruses can cause significant respiratory illness contributing to bronchiectasis.
What mycobacterial infection is associated with bronchiectasis?
Tuberculosis (TB)
TB can cause direct damage to the airways leading to bronchiectasis.
What condition can cause direct damage leading to bronchiectasis?
Gastroesophageal reflux disease (GERD)
GERD can lead to aspiration and subsequent lung damage.
Name a genetic disorder that can cause bronchiectasis.
Cystic fibrosis (CF)
CF is a common cause of bronchiectasis in younger populations.
What is Kartagener’s syndrome?
Genetic ciliopathy characterised by triad of bronchiectasis, sinusitis, and situs inversus
It involves abnormal ciliary function, leading to respiratory issues.
What is Allergic Bronchopulmonary Aspergillosis (ABPA)?
Occurs in asthma and CF, causes bronchiectasis due to IgE and IgG antibodies
ABPA is an allergic reaction to the fungus Aspergillus.
What is primary immune deficiency that can lead to bronchiectasis?
Hypogammaglobulinemia
This condition is characterised by low serum antibody levels.
Name a secondary immune deficiency that can cause bronchiectasis.
HIV
Other secondary causes include lymphoid malignancies.
What percentage of bronchiectasis cases are related to rheumatological causes?
53%
Rheumatological diseases can compromise lung function and lead to bronchiectasis.
What is the pathophysiology of Bronchiectasis?
Acquired through a Vicious Cycle of infection and inflammation.
What triggers the Vicious Cycle in Bronchiectasis?
Initial infection which releases toxins.
What is the first step in the Vicious Cycle of Bronchiectasis?
Inflammatory response causes release of lymphocytes, macrophages, and characteristic neutrophil infiltrate.
What are the consequences of recurrent airway/lung infections in Bronchiectasis?
Ciliary dysfunction, excessive mucus, and chronic airway inflammation.
What does neutrophil infiltrate release in Bronchiectasis?
Proteolytic enzyme neutrophil elastase (NE).
What are the effects of neutrophil elastase (NE) in Bronchiectasis?
Impairs mucociliary clearance, stimulates goblet cell mucus hypersecretion, and destroys bronchial wall elastin.
What increases airway susceptibility to microorganism colonization in Bronchiectasis?
Impaired mucociliary clearance and abnormal mucus.
What happens after microorganism colonization in Bronchiectasis?
More inflammation is triggered, and elastin begins to destroy bronchi wall elastin, causing permanent dilation.
What triggers the restart of the Vicious Cycle in Bronchiectasis?
Dilation and mucus pooling trigger inflammation.
What is the hallmark feature of Bronchiectasis?
Persistent cough that brings up foul-smelling and purulent sputum (daily over long period of time)
What are some common symptoms of Bronchiectasis?
Whistling/wheezing sound when breathing
Shortness of breath
Haemoptysis
Fever and/or night sweats/chills
Generalised malaise or weight loss
Nail clubbing
What are the four main classes of bronchiectasis?
- Cylindrical/longitudinal: Uniform luminal dilation
- Varicose: Alternating luminal dilation and constriction with uneven wall thickening
- Spherical/saccular/cystic: Intermittent spherical ballooning which resembles pouches
- Traction: Fibrotic tissues pulling bronchi and forcing them to dilate
What characterizes cylindrical bronchiectasis?
Uniform luminal dilation
What characterizes varicose bronchiectasis?
Alternating luminal dilation and constriction with uneven wall thickening
What characterizes spherical/saccular/cystic bronchiectasis?
Intermittent spherical ballooning which resembles pouches
What characterizes traction bronchiectasis?
Fibrotic tissues pulling bronchi and forcing them to dilate
Secondary to fibrotic lung diseases eg. Pulmonary fibrosis, asbestosis
How is bronchiectasis diagnosed?
Diagnosis is confirmed with HRCT scan of chest.
Chest x-ray is not first-line scan as 50% cases are missed.
What should be investigated in bronchiectasis?
Underlying condition should be investigated.
This includes sputum microbiology culture, lung function tests, IRT test, sweat test for CF, and inflammatory markers.
What is the management for bronchiectasis?
Treat underlying disorder.
This includes addressing bacterial infection, humoral deficiencies, and airway clearance.
What antibiotics are used for bacterial infection in bronchiectasis?
IV Ciprofloxacin or PO amoxicillin covers most bacteria that cause bronchiectasis.
What is the treatment for humoral (antibody) deficiencies in bronchiectasis?
Immunoglobulin replacement.
What is a recommended therapy for airway clearance in bronchiectasis?
Chest physiotherapy.
