Bronchiectasis

Question 1

Define bronchiectasis

Answer 1

Irreversible abnormal dilatation of bronchi, accompanied by chronic airway inflammation (walls and adjacent lung parenchyma)

Question 2

Pathophysiology of bronchiectasis

Answer 2

Initial insult: primary infectionChronic inflammation due to host response to micro-organisms colonising the airways-> this leads to subsequent dvpmt of bronchial wall oedema and increased mucus production-> chronic inflammation destroys elastin and cartilage which causes dilation and weakness of bronchial walls-> inflam cells (neutrophils, T cells) release inflam cytokines, proteases and ROS that progressively destroy the airways

Question 3

How does the initial insult lead to eventual bronchiectasis?

Answer 3

Primary infection leads to increased inflam, resulting in bronchial damage and therefore serves as a nidus for subsequent colonisation -> vicious cycle

Question 4

Aetiology of bronchiectasis

Answer 4

Post inflammatory (non obstructive)- pneumonia, measles, whooping cough- congenital hypogammaglobulinaemia, CF- allergic bronchopulmonary aspergillosis (building sites)Post obstructive (stasis):- neoplasm- foreign body- inspissated mucus (asthma)- external compression: hilar LN, aortic aneurysm#1: CF - pt with CF will almost always have bronchiectasisOther- impairment of ciliary clearing system e.g. Kartagener’s Syndrome - Chronic lung infections- Impaired immunity (hypogammglobulinaemia, HIV, CLL)- Congenital: pulmonary sequestration

Question 5

Symptoms of bronchiectasis

Answer 5

• Cough- Chronic sputum production - purulent, tenacious (clingy) and daily- Intermittent haemoptyses- Dyspnoea- Intermittent pleuritic pain (usually in association with infections)- Lethargy/malaise

Question 6

Signs of bronchiectasis

Answer 6

Coarse inspiratory and expiratory crackles on auscultationAirflow obstruction with wheeze

Question 7

Dx of bronchiectasis

Answer 7

Clinical picture (Sx and signs)with CT chest

Question 8

Management of bronchiectasis

Answer 8

Prophylactic AbxAggressive pulmonary hygieneSmoking cessationPneumococcal and flu vaccine

Question 9

What is the order of progressive bacterial colonisation?

Answer 9

Different bacteria colonise the airways at different stages of the disease. The usual order is:1. Staphylococcus aureus2. Haemophillus influenzae3. Morazella catarrhalis4. Pseudomonas species *major concern

Question 10

Exacerbation of bronchiectasis Sx

Answer 10

Increase sputum volume and tenacity (above baseline)Pleuritic painHaemoptysisWheezeSystemic: fevers, lethargy, anorexia

Question 11

What is the order of progressive bacterial colonisation (causing exacerbations)?

Answer 11

Different bacteria colonise the airways at different stages of the disease. The usual order is:1. Staphylococcus aureus2. Haemophillus influenzae3. Morazella catarrhalis4. Pseudomonas species *major concern

Question 12

Rx of exacerbation of bronchiectasis

Answer 12

Long term oral antibiotics: amoxicillin 500mg bd or doxycyline 100 mg odif Pseudomonas aeruginosa colonised: 2 week course of PO ciprofloxacin at 750mg bd

Question 13

Management of bronchiectasis

Answer 13

Treat underlying cause e.g. CF, hypogammaglobulinopathyProphylactic AbxAggressive pulmonary hygieneSmoking cessationPneumococcal and flu vaccine

Question 14

Rx of exacerbation of bronchiectasis

Answer 14

Long term oral antibiotics: amoxicillin 500mg bd or doxycyline 100 mg odIf Pseudomonas aeruginosa colonised: 2 week course of PO ciprofloxacin at 750mg bd

Question 15

Location of pathology

Answer 15

Usually in the lower lobes, bilaterally, involving the airways that are most verticalDistal bronchi and bronchioles are most affected