Bronchiectasis Flashcards
What are some DDs for cough, clubbing and coarse crackles?
a. ) Bronchiectasis
b. ) Carcinoma of the lung- also likely to see nicotine staining and lymphadenopathy
c. ) Lung abscess
d. ) Pulmonary fibrosis
what are the causes of bronchiectasis?
• Respiratory childhood infections
o Pertussis
o Measles
o TB
• Bronchial obstruction o Foreign body o Chronic aspiration o Endobronchial tumour o Lymph nodes (TB, malignancy, sarcoidosis) o Granulomata (TB and sarcoidosis)
• Fibrosis
o Long standing pulmonary fibrosis
o Fibrosis complicated by old TB, sarcoidosis, unresolved and supprative pneumonia
• Muco-ciliary clearance defects
o CF
o Immotile cilia syndrome
o Young syndrome
• Allergic broncho-pulmonary aspergillosis
• Autoimmune diseases
o Sjogren syndrome
o IBD
o Rheumatoid arthritis
what is the pathophysiology of bronchiectasis?
o Bronchiectasis is caused by abnormal bronchial wall dilatation, destruction and transmural inflammation.
o The abnormal dilatation of the proximal and medium sized bronchi is caused by the destruction of the muscular and elastic components of the bronchial walls. This leads to inflammation, oedema, scarring and ulceration of the bronchial wall.
o Severely impaired mucus clearance causes colonization and infection. This results in further bronchial damage, dilatation, impaired clearance of secretions, recurrent infections, and more bronchial damage- a vicious cycle
What are the complications of bronchiectasis
- Pneumonia
- Respiratory failure
- Empyema
- Collapse
- Pneumothorax
- Met cerebral abscess
- Pul. Hypertension
Is bronchiectasis associated with smoking?
o No, but smoking is associated with COPD and 30% of patients with COPD have evidence of bronchiectasis on CT
What is the cause and significance of wheeze in a patient with bronchiectasis?
o Wheeze -> signifies airway obstruction due to airway collapsibility (due to destruction of the muscular and elastic components of the wall), airway obstruction (due to secretions, lymph nodes, malignancy and granulomata) and co-existent obstructive airway disease
what is the role of CT in diagnosing bronchiectasis?
o High resolution CT is the gold standard
o Looking for ‘signet ring sign’: bronchial diameter greater than adjacent vessel diameter
What would the spirometery findings be in this patient?
o Obstructive pattern with FEV1:FVC
what are the most common resp. pathogens in patients with bronchiectasis?
- Pseudomonas aeruginosa
- Staph aureus
- Haemophilus aeruginosa
- Strep pneumonia
- Aspergillus species
How would you manage a patient with bronchiectasis?
• General measures
o Stop smoking
o Adequate nutritional and supplementation
o Immunization for influenza and pneumococcal pneumonia
o Long-term oxygen therapy
o Confirm immunity to measles, pertussis and rubella
- Antibiotics
- Postural drainage and physiotherapy
- Bronchodilator therapy
- Anti-inflammatory medication- inhaled or oral corticosteroids
- Surgery- surgical resection, lung transplantation for CF, Foreign body and tumour removal
