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Clinical lectures: Yr2 > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A

Obstructive airway disease characterised by permanent dilation (enlargement) of the bronchi

Bronchiectasis can lead to chronic cough and sputum production.

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2
Q

What is the peak incidence age for bronchiectasis?

A

Individuals over 65 years old

However, bronchiectasis can occur at any age.

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3
Q

Is bronchiectasis more common in men or women?

A

More common in women

This trend is observed in epidemiological studies.

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4
Q

Name a bacterial cause of bronchiectasis.

A

Pneumonia due to bordetella pertussis

Other bacterial causes include staphylococcus, haemophilus influenzae, and klebsiella.

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5
Q

What viral infections can lead to bronchiectasis?

A

Adenovirus, influenza, measles

These viruses can cause significant respiratory illness contributing to bronchiectasis.

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6
Q

What mycobacterial infection is associated with bronchiectasis?

A

Tuberculosis (TB)

TB can cause direct damage to the airways leading to bronchiectasis.

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7
Q

What condition can cause direct damage leading to bronchiectasis?

A

Gastroesophageal reflux disease (GERD)

GERD can lead to aspiration and subsequent lung damage.

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8
Q

Name a genetic disorder that can cause bronchiectasis.

A

Cystic fibrosis (CF)

CF is a common cause of bronchiectasis in younger populations.

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9
Q

What is Kartagener’s syndrome?

A

Genetic ciliopathy characterised by triad of bronchiectasis, sinusitis, and situs inversus

It involves abnormal ciliary function, leading to respiratory issues.

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10
Q

What is Allergic Bronchopulmonary Aspergillosis (ABPA)?

A

Occurs in asthma and CF, causes bronchiectasis due to IgE and IgG antibodies

ABPA is an allergic reaction to the fungus Aspergillus.

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11
Q

What is primary immune deficiency that can lead to bronchiectasis?

A

Hypogammaglobulinemia

This condition is characterised by low serum antibody levels.

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12
Q

Name a secondary immune deficiency that can cause bronchiectasis.

A

HIV

Other secondary causes include lymphoid malignancies.

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13
Q

What percentage of bronchiectasis cases are related to rheumatological causes?

A

53%

Rheumatological diseases can compromise lung function and lead to bronchiectasis.

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14
Q

What is the pathophysiology of Bronchiectasis?

A

Acquired through a Vicious Cycle of infection and inflammation.

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15
Q

What triggers the Vicious Cycle in Bronchiectasis?

A

Initial infection which releases toxins.

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16
Q

What is the first step in the Vicious Cycle of Bronchiectasis?

A

Inflammatory response causes release of lymphocytes, macrophages, and characteristic neutrophil infiltrate.

17
Q

What are the consequences of recurrent airway/lung infections in Bronchiectasis?

A

Ciliary dysfunction, excessive mucus, and chronic airway inflammation.

18
Q

What does neutrophil infiltrate release in Bronchiectasis?

A

Proteolytic enzyme neutrophil elastase (NE).

19
Q

What are the effects of neutrophil elastase (NE) in Bronchiectasis?

A

Impairs mucociliary clearance, stimulates goblet cell mucus hypersecretion, and destroys bronchial wall elastin.

20
Q

What increases airway susceptibility to microorganism colonization in Bronchiectasis?

A

Impaired mucociliary clearance and abnormal mucus.

21
Q

What happens after microorganism colonization in Bronchiectasis?

A

More inflammation is triggered, and elastin begins to destroy bronchi wall elastin, causing permanent dilation.

22
Q

What triggers the restart of the Vicious Cycle in Bronchiectasis?

A

Dilation and mucus pooling trigger inflammation.

23
Q

What is the hallmark feature of Bronchiectasis?

A

Persistent cough that brings up foul-smelling and purulent sputum (daily over long period of time)

24
Q

What are some common symptoms of Bronchiectasis?

A

Whistling/wheezing sound when breathing
Shortness of breath
Haemoptysis
Fever and/or night sweats/chills
Generalised malaise or weight loss
Nail clubbing

25
Q

What are the four main classes of bronchiectasis?

A
  1. Cylindrical/longitudinal: Uniform luminal dilation
  2. Varicose: Alternating luminal dilation and constriction with uneven wall thickening
  3. Spherical/saccular/cystic: Intermittent spherical ballooning which resembles pouches
  4. Traction: Fibrotic tissues pulling bronchi and forcing them to dilate
26
Q

What characterizes cylindrical bronchiectasis?

A

Uniform luminal dilation

27
Q

What characterizes varicose bronchiectasis?

A

Alternating luminal dilation and constriction with uneven wall thickening

28
Q

What characterizes spherical/saccular/cystic bronchiectasis?

A

Intermittent spherical ballooning which resembles pouches

29
Q

What characterizes traction bronchiectasis?

A

Fibrotic tissues pulling bronchi and forcing them to dilate

Secondary to fibrotic lung diseases eg. Pulmonary fibrosis, asbestosis

30
Q

How is bronchiectasis diagnosed?

A

Diagnosis is confirmed with HRCT scan of chest.

Chest x-ray is not first-line scan as 50% cases are missed.

31
Q

What should be investigated in bronchiectasis?

A

Underlying condition should be investigated.

This includes sputum microbiology culture, lung function tests, IRT test, sweat test for CF, and inflammatory markers.

32
Q

What is the management for bronchiectasis?

A

Treat underlying disorder.

This includes addressing bacterial infection, humoral deficiencies, and airway clearance.

33
Q

What antibiotics are used for bacterial infection in bronchiectasis?

A

IV Ciprofloxacin or PO amoxicillin covers most bacteria that cause bronchiectasis.

34
Q

What is the treatment for humoral (antibody) deficiencies in bronchiectasis?

A

Immunoglobulin replacement.

35
Q

What is a recommended therapy for airway clearance in bronchiectasis?

A

Chest physiotherapy.

Clinical lectures: Yr2 (41 decks)

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