Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Bronchiectasis is a chronic condition characterised by permanent dilation and damage of the bronchi, leading to mucus accumulation and recurrent infections.

Question 2

What are the common causes of bronchiectasis?

Answer 2

Causes include recurrent infections, cystic fibrosis, primary ciliary dyskinesia, immune deficiencies, and allergic bronchopulmonary aspergillosis (ABPA).

Question 3

What are the common symptoms of bronchiectasis?

Answer 3

Symptoms include chronic cough, copious sputum production, recurrent chest infections, haemoptysis, and breathlessness.

Question 4

What are the signs of bronchiectasis on clinical examination?

Answer 4

Signs include crackles on auscultation, wheezing, finger clubbing, and hypoxaemia in severe cases.

Question 5

What is the pathophysiology of bronchiectasis?

Answer 5

It involves chronic inflammation, infection, and impaired mucus clearance, leading to bronchial wall damage and dilation.

Question 6

What are the risk factors for developing bronchiectasis?

Answer 6

Risk factors include severe or recurrent childhood respiratory infections, cystic fibrosis, smoking, and immune deficiencies.

Question 7

How is bronchiectasis diagnosed?

Answer 7

Diagnosis is based on clinical history, sputum analysis, and imaging, particularly high-resolution CT (HRCT).

Question 8

What are the typical CT findings in bronchiectasis?

Answer 8

Findings include bronchial dilation, thickened bronchial walls, mucus plugging, and lack of tapering of the bronchi.

Question 9

What are the common pathogens causing infections in bronchiectasis?

Answer 9

Common pathogens include Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, and Streptococcus pneumoniae.

Question 10

What are the main types of bronchiectasis?

Answer 10

Types include cystic fibrosis-related bronchiectasis and non-cystic fibrosis bronchiectasis.

Question 11

What investigations are used in the workup of bronchiectasis?

Answer 11

Investigations include sputum culture, chest X-ray, HRCT, spirometry, and blood tests for immune function and allergens.

Question 12

What is the role of spirometry in bronchiectasis?

Answer 12

Spirometry typically shows an obstructive pattern with reduced FEV1/FVC ratio.

Question 13

What are the differential diagnoses for bronchiectasis?

Answer 13

Differential diagnoses include COPD, chronic bronchitis, cystic fibrosis, and asthma.

Question 14

What is the medical management of bronchiectasis?

Answer 14

Management includes airway clearance techniques, inhaled bronchodilators, antibiotics for infections, and mucolytics.

Question 15

What airway clearance techniques are used in bronchiectasis?

Answer 15

Techniques include physiotherapy, postural drainage, and devices like oscillatory positive expiratory pressure (PEP) devices.

Question 16

What is the role of antibiotics in bronchiectasis?

Answer 16

Antibiotics are used to treat acute infections, eradicate chronic infections (e.g., Pseudomonas), and reduce exacerbations.

Question 17

When is long-term antibiotic therapy considered in bronchiectasis?

Answer 17

Long-term antibiotics are considered for patients with frequent exacerbations (≥3 per year) or chronic colonisation with resistant bacteria.

Question 18

What are the complications of bronchiectasis?

Answer 18

Complications include recurrent infections, haemoptysis, respiratory failure, and cor pulmonale.

Question 19

What lifestyle modifications are recommended for bronchiectasis patients?

Answer 19

Modifications include smoking cessation, regular exercise, and vaccination against influenza and pneumococcus.

Question 20

What vaccinations are recommended for bronchiectasis patients?

Answer 20

Vaccinations include annual influenza and pneumococcal vaccines to reduce respiratory infections.

Question 21

What is the prognosis for bronchiectasis?

Answer 21

Prognosis varies; patients with mild disease may remain stable, but those with severe or recurrent infections can experience progressive decline.

Question 22

What is the role of surgery in bronchiectasis?

Answer 22

Surgery, such as lobectomy, is considered in localised disease refractory to medical management or with significant haemoptysis.

Question 23

What is allergic bronchopulmonary aspergillosis (ABPA)?

Answer 23

ABPA is a hypersensitivity reaction to Aspergillus species, associated with bronchiectasis and often seen in asthma or cystic fibrosis patients.

Question 24

How is allergic bronchopulmonary aspergillosis (ABPA) managed in bronchiectasis patients?

Answer 24

Management includes corticosteroids and antifungal agents (e.g., itraconazole).

Question 25

What is the global prevalence of bronchiectasis?

Answer 25

Bronchiectasis is more common in low-income countries and among older adults, but exact prevalence varies based on diagnostic criteria and population studies.