Bronchiectasis

Question 1

What is it?

Answer 1

Bronchectasis is irreversible dilatation of the bronchi causing increased susceptibility to chronic infection

Question 2

Where can the bronchi are affected?

Answer 2

Anywhere beyond the supportive rings of cartilage

Question 3

What can cause bronchiecstasies? Name 3

Answer 3

Cystic fibrosis, pneumonia, primary TB, inhaled foreign body, bronchial tumours, reactivated TB

Question 4

Pathology?

Answer 4

The dilated airways become lined with granulation tissue (neutrophils etc), epithelia becomes damaged and inflamed, inflammation and fibrosis of deeper layers of the bronchial walls and hyper trophy of bronchial arteries

Question 5

What are the clinical features of bronchectasis?

Answer 5

Chronic productive cough worse in the mornings and brought on by posture changes, pneumonia, pleurisy, haemoptysis, low grade fever, clubbing, anorexia

Question 6

Investigations include?

Answer 6

Sputum culture (pseudonomas, fungi such as aspergillus, mycobacteria), CXR (in advanced disease only), high resolution CT (shows thickened dilated airways), ciliary function test (use saccharine droplet in nose and time till taste it)

Question 7

Management is?

Answer 7

Physiotherapy and antibiotics (same as those in COPD in larger and longer doses) and in some cases surgical excision of bronchi ecstatic area I.e. One lobe affected only

Question 8

Prognosis is?

Answer 8

Progressive and culminates in respiratory failure if associated with ciliary dysfunction or cystic fibrosis. If not the quite good if given aggressive antibiotic therapy and physiotherapy often

Question 9

Prevention strategies?

Answer 9

Most commonly follows measles, rubella or primary TB so prophylaxis is essential. Also early treatment of bronchial obstruction is important