Bronchiectasis

Question 1

COMMS: Bronchiectasis

Answer 1

• Long-standing condition where the main air tubes of the lungs known as the bronchi become abnormal wide.
• This leads to abnormally large amounts of mucus building up and can lead to further infections
• It is generally caused by permeant damage to the lungs e.g. from a severe childhood infection or from diseases such as cystic fibrosis
• Although the damage is permeant, treatments can help ease symptoms and prevent further damage

Question 2

Define bronchiectasis

Answer 2

• Permanent dilation of the bronchi and bronchioles

- Due to chronic infection or inflammation

Question 3

What can cause bronchiectasis?

Answer 3

• Common infections: TB, measles, pertussis, pneumonia
• Cystic fibrosis
• Bronchial obstruction: malignancy
• Immune deficiency: selective IgA, hypogammaglobulinaemia
• Allergic bronchopulmonary aspergillosis (ABPA)
• Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome

Question 4

What are the main symptoms of bronchiectasis?

Answer 4

• Productive cough
• Fever
• SOB
• Fatigue
• Weight loss

Question 5

What are the main signs of bronchiectasis?

Answer 5

• Haemoptysis
• Clubbing
• Pleuritic chest pain
• Wheezing
• Crackles w/ high-pitched squeaks

Question 6

What are the main investigations for bronchiectasis?

Answer 6

Culture
-Sputum (growth and sensitivities)

Bloods
-WBC (if eosinophils high may indicate aspergillosis

Imaging

• CXR
• CT (GOLD)

Other
-Specific tests e.gg. for CF/RA/aspergillosis

Question 7

Whata re the CXR signs for bronchiectasis?

Answer 7

• Tram lines (bronchial wall thickening)
• Tube/ovoid opacities
• Obscured hemi-diaphragm

Question 8

What are the CT signs for bronchiectasis?

Answer 8

• Thickened dilated airways w/ or w/o fluid levels
• Varicose constrictions
• Cysts
• Tree bud pattern

Question 9

What is the conservative management for bronchiectasis?

Answer 9

Exercise
Improved nutrition
Airway clearance therapy

Question 10

What is the medical management for bronchiectasis?

Answer 10

Inhaled bronchodilators
(salbutamol, ipratropium, tiotropium)

Antibiotics (for exacerbations)

Question 11

Can surgery be offered to bronchiectasis patients?

Answer 11

• Localised disease can be resected

- Can offer lung transplant

Question 12

What medical therapy is not offered in bronchiectasis?

Answer 12

• steroids
• mucolytics
• leukotriene receptor antagonists