Bronchiectasis

Question 0

What are some potential causes of bronchiectasis?

Answer 0

1. Idiopathic (80%)
2. Congenital
3. COPD
4. Mucociliary dysfunction
5. Immune deficiency
6. Pulmonary fibrosis
7. Post obstruction eg foreign body
8. Post infection
9. Recurrent small volume aspiration
10. Systemic inflammatory disease

Question 1

What is bronchiectasis?

Answer 1

Bronchiectasis is classically defined as a pathological diagnosis typically confirmed by radiology. Bronchiectasis is characterised by abnormal, irreversible bronchial dilatation or a fixed increase in airway diameter. Bronchiectasis is currently usually diagnosed by a chest high-resolution computed tomography (c-HRCT) scan

Question 2

What features may suggest bronchiectasis I’m a patient with chronic respiratory symptoms?

Answer 2

Digital clubbing
Suspected COPD but no/ minimal smoking history
Recurrent or severe pneumonia
Unusual organisms in sputum eg pseudomonas
Childhood with environmental/ social disadvantage

Question 3

What investigations could be performed to look for a cause for bronchiectasis?

Answer 3

FBC, IgG, IgA, IgM, sputum culture including for mycobacterium, test for CF transmembrane conductance regulator gene

Question 4

What antibiotics should be used in an acute exacerbation of bronchiectasis?

Answer 4

• ideally based on most recent sputum

- empirically use augmentin or doxycycline for at least 10 days