Bronchiectasis Flashcards
Respiratory pathogens in bronchiectasis
- Staph aureus
- H. Influenzae
- Pseudomonas aeruginosa
- Strep. Pneumoniae
- Klebsiella pneumoniae
- Aspergillus species
Definition
Permanent dilation of the bronchi with daily production of mucopurulent sputum caused by repeated infection and inflammation of the large and small airways
pathogenesis of brochiectasis
Three factors that add up to cause:
- infectious insult
- airway obstruction
- defect in host defence
Cause infection not to be cleared properly
- disordered anatomy leads to secondary bacterial colonisation, perpuating inflammatory change and damaging the mucociliary escalator
- this prevents bacterial clearance and leads to further airway damage
- major airways and bronchioles are involved with mucosal oedema, inflammation and ulceration
- terminal bronchioles become obstructed with secretions, leading to volume loss
- Chronic host inflammatory response ensues with free radical formation and the production of neutrophil elastase further contributing to the inflammatoru process
- bronchial neovascularisation occurs with hypertrophy and tortusity of the bronchial arteries (which are at systemic pressure) which may lead to intermittent haemoptysis
Two types of bronchiecasis
- Focal
- airway obstruction
- tumour
- extrinsic lymph node
- inhaled foreign body
- airway obstruction
- Diffuse
- defect in host defences
- ciliary dyskinesis
- hypogammagobulinaemia
- AIDS
- infectious insult
- acute bronchitis
- defect in host defences
Symptoms of bronchiectasis
- cough
- sputum
- breathless ness
- chest pain
- chronic sinusitis
- haemoptysis - can be massive (>300ml/s day)
diagnosis should be considered in yound adults who have never been smokers
Signs of bronchiectasis
- general: cachexia and tachypnoea
- Chest: Coarse crackles that occur wit coughing, wheeze
- hands: finger clubbing
- Signs of chronic respiratory failure in advanced disease
- Normal or obstructive spirometry
Investigations of bronchiectasis
CXR
- dilated and thickened airways
- ring shadows
- tramlines
- usually in lower zones
- old tb or CF give upper zone changes
CT Chest (HRCT)- to assess extent and distrubtion of disease
- dilated airways
- airways dont taper
- bronchial wall thickenening
- signet ring sign (airway with vessel , airway bigger than vessel)
- mucus airways
- grape like
Sputum
- colour and volume
- microscopy and culture
Blood tests
- aspergillus serology
- immunoglobulins
- alpha1-antitrypsin levels
- arterial blood gases
Lung function tests
- normal or obstructive spirometry
Exacerbations
Increased brethlessness and wheeze, increased sputum volumes, more purulent sputum
May have 2 or 3 exacerbations per year
Common bacteria involved:
- Streptococcus pneumoniae
- Haemophilus influenzea
- Moraxella catarrhalis
- Pseudomonas aeruginosa
Chronic colonisation
- Pseudomonas aeruginosa- worse progniss
- Staphylococcus aureus
Treatment for acute exacerbations
- Antibiotics for acute exacerbations only
- Chose antibiotics according to sputum culture results
- May need treatment for 10 -14 days
- patients known to culture psuedomonas will require either oral ciprofloxacin or IV antibiotics
- Prevent exacerbations
- long-term oral antibiotics in patients with >3 exacerbations a year
- Physiotherapy
- Sputum clearance techniques
- Immunoglobulin replacement
- Other – bronchodilators, oxygen, surgery
Prognosis of bronchiectasis
Complications
- Pneumonia
- Pneumothorax
- Cerebral abscess
Prognosis depends on severity
- severe disease may progress to respiratory failure
- mild disease may not cause any problems
- Progressive airflow obstruction → respiratory failure
Treatment of bronchiectasis
- Chest Physiotherapy = airway clearance techniques
- Prompt antibiotic therapy for exacerbations
- Long-term treatment with low dose azithromycin 3x/week
- Bronchodilators/inhaled corticosteroids if any airflow
obstruction - Surgery occasionally for localised disease
- Supplementary oxygen
- Nutritional
