Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Permenant dilation of the airways, due to desctruction of the elastic and muscular tissue of the bronchial walls.

Question 2

Outline the pathophysiology of bronchiectasis.

Answer 2

• Infection – bacterial colonisation of the tissue leads to dilation and fibrosis of airways
• Inflammation leads to increased mucus production, bronchial wall oedema, release of cytokines
• Damage to airways predisposes to further colonisation (vicious cycle)

Question 3

What are some common causes of bronchiectasis?

Answer 3

POST INFECTIOUS: TB, pneumonia, whooping cough

GENETIC: Cystic fibrosis, alpha-1 anti-trypsin deficiency, Kartagener’s syndrome, connective tissue disorders

OBSTRUCTION: tumour e.g. lymphadeonpathy causing external compression, foreign body, broncholith

OTHER: Inflammatory diseases e.g. IBD, RhA, primary ciliary dyskinesia, allergc bronchopulmonary aspergillosis

Question 4

What is alpha-1 anti-trypsin deficiency?

Answer 4

Congenital disorder
Alpha-1 antryptase is a protease inhibitor, produced in liver.
Deficiency allow breakdown of elastin by neutrophils

Question 5

Symptoms of bronchiectasis

Answer 5

Cough, with sputum (purulent or, in 50%, haemoptysis), dyspnoea, fever, weight loss
Symptoms come on after an acute resp illness

Question 6

Signs of bronchiectasis

Answer 6

INSPECTION: clubbing
AUSCULATION: wheeze, rhonchi, high-pitched inspiratory squeaks, corase crackles at bases which shift with coughing

Question 7

Investigations for bronchiectasis

Answer 7

FBC - leukocytosis
Sputum - culture and sensitivity
CXR - dilated bronchi with tramline shadows
High-res chest CT - dilated bronchi and thickened walls

Question 8

Which is the best diagnostic method for bronchiectasis?

Answer 8

High-res chest CT

Question 9

Management of bronchiectasis

Answer 9

• ANTIBIOTICS - x2, one against Pseudomonas - this can be oral cipro. May need prophylaxis in >3 exacerbations/year
• STEROIDS - inhaled e.g. fluticasone
• PHYSIO - sputum and mucus clearance
• BRONCHODILATORS - if pt has responsive disease
• MAINTAIN HYDRATION
• SURGERY - if necessary - resection or lung transplant

Question 10

Complications of bronchiectasis

Answer 10

LIFE-THREATENING HAEMOPTYSIS CAN CAUSE BRONCHIAL ARTERY EMBOLISATION
Pleural effusion, empyema, pneumothorax, cor pulmonale, amyloidosis

Question 11

What is cor pulmonale?

Answer 11

LUNGS CAUSE HEART TO FAIL.

RV enlargement and failure due to:

• increased pressure in lungs
• increased vascular resistance e.g. pulmonic stenosis