Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Abnormal and permanent dilation of the central and medium sized airways

Question 2

What problems occur as a result of bronchiectasis?

Answer 2

More mucus than usual gathers in the affected bronchi because of impaired clearance

This makes the bronchi more vulnerable to infection.

Infection + inflammation damage the airways further

End result is fibrosis

Question 3

Describe the vicious cycle of bronchiectasis?

Answer 3

RESPIRATORY TRACT INFECTION

causes

BRONCHIAL INFLAMMATION

causes

RESPIRATORY TRACT DAMAGE

causes

SUSCEPTIBILITY TO RESPIRATORY TRACT INFECTION

Question 4

Which organisms are usually to blame for the infections?

Answer 4

Haemophilus influenzae
Strep. pneumonia
Staph. aureus

Pseudomonas aeruginosa

Question 5

What are the causes of bronchiectasis?

Answer 5

Post infection:

Congenital: CF

Loss of surrounding lung volume

Inhaled irritants: aspiration, drugs, ammonia

Obstructive lesion: tumour, foreign body

Connective tissue diseases

IBD, RA

Asthma

Post-transplant
Post-radiotherapy

Question 6

What are the post-infective causes of bronchiectasis?

Answer 6

• measles, whooping cough
• previous pneumonia
• granulomatous disease (TB)

Question 7

What are the congenital causes of bronchiectasis?

Answer 7

• cystic fibrosis
• alpha-1 antitrypsin deficiency
• primary immunodeficiency

Question 8

Clinical features of bronchiectasis?

Answer 8

Cough

Production of purulent sputum

Haemoptysis

Recurrent exacerbations with a long recovery time

Dyspnoea

Chest pain

Finger clubbing

Crepitations (crackling lung sounds)

Question 9

What complications can arise from bronchiectasis?

Answer 9

Pneumonia
Pleural effusion
Pneumothorax
Cerebral abscess
Amyloidosis

Question 10

Investigations for bronchiectasis?

Answer 10

Sputum culture: to see what pathogen it is

CXR: normal or dilated bronchi with thickened walls, cysts

CT: shows airway dilation, thickening, cysts that don’t show on an x-ray

Spirometry

Bronchoscopy if necessary to find source of haemoptysis

Immunology: antibodies, IgG, IgA, IgM

Question 11

Management of bronchiectasis.

Answer 11

Postural drainage: lying in a position that helps get mucus out of lungs

Mucolytics: carbocysteine

Antibiotics: according to bacteria found

Bronchodilators

Corticosteroids (anti-inflammatory)

Surgery in severe cases