Bronchiectasis

Question 1

What is the signet ring sign in bronchiectasis?

Answer 1

Vessel smaller than the thickened bronchi next to it.

Question 2

Three patterns of bronchiectasis?

Answer 2

Cylindrical (tram track and signet ring signs)
Varicose (beaded appearence of bronchi)
Cystic (cyst like bronchi to surface with even air fluid levels)

Question 3

Treatment of bronchiectasis- key points?

Answer 3

Treat underlying cause eg AAT replacemet or IVIG
Chest PT for airway clearance
Pulmonary rehab (reduces exac and improves 6MWT)
Consider macrolide therapy if there are frequent exacerbations
Nebulised hypertonic saline or mannitol increases QOL
Vaccinations
Symbicort may reduce sputum volume (no effect on exac frequency)
Sputum culture:
-non-pseudomonas- target
-pseudomonas- can attempt eradication if FIRST isolation or use nebulised antibiotics
-Non TB mycobact- consider treating if more than two cultures positive. Avoid macrolide monotherapy.

NOT NAC, NOT recombinant DNAse

Question 4

What is the benefit of macrolide therapy?

Answer 4

Reduces FREQUENCY of exacerbation
No change in FEV1, symptoms, colonisation, QOL
Also only a temporary benefit as become resistant.
MUST exclude non TB myco infection first because macrolide resistant infection can rarely be cured

RISK QT prolongation

Question 5

What is the effect of growing pseudomonas on disease progression?

Answer 5

More rapid decline in FEV1

Question 6

Distribution of bronchiectasis in helping to know the cause?

Answer 6

Upper- CF
Hilar- ABPA
Lingular and middle- TB
Lower- idiopathic
Middle and lower-Primary ciliary dyskinesia