Bronchiectasis

Question 1

Definition of bronchiectasis

Answer 1

Permanent dilation of bronchi due to destruction of the elastic and muscular components of the bronchial wall

Question 2

IIII MCG

Causes of bronchiectasis

Answer 2

(IIII MCG):

• Infectious (e.g. pneumonia, TB)
• Immunodeficiency
• Inflammatory bowel disease
• Idiopathic
• Mechanical (e.g. aspiration, obstruction)
• Congenital
• Genetic (e.g. CF, alpha-1 antitrypsin deficiency)

Question 3

Symptoms of bronchiectasis

Answer 3

• Chronic productive cough - purulent ± bloody sputum
• Dyspnoea
• Pleuritic chest pain
• Wheezing
• Fatigue
• Weight loss

Question 4

Signs of bronchiectasis

Answer 4

• Clubbing
• Coarse, late-inspiratory crackles
• Wheeze
• Fever

Question 5

Investigations for bronchiectasis

Answer 5

• Sputum MCS
• FBE - anaemia, elevated WCC
• CXR - dilated bronchi
• High-resolution CT - tram track sign, signet ring
• Other - for cause:
  
  • Serum immunoglobulins
  • Autoimmune screen (RF, ANA)
  • CF sweat chloride

Question 6

Management of bronchiectasis

Answer 6

• Exercise and physiotherapy
• Antibiotics - for acute exacerbations only
• Surgical excision - if focal bronchiectasis