Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Abnormal fixed dilation of the bronchi usually due to fibrous scarring following infection (TB, pneumonia, CF, etc)
Dilated airways accumulated purulent secretions

Question 2

Bronchiectasis is particularly linked to which conditions?

Answer 2

COPD
Cystic Fibrosis
Pertussis (in childhood)

Question 3

why are the airways filled with pus in bronchiectasis?

Answer 3

weakened mucociliary clearance

Question 4

What is the macroscopic appearance of the bronchioles? (In bronchiectasis)

Answer 4

Cystic - clusters of close-ended cysts filled with pus
Cylindrical - tubular appearance
Varicose - indentations (constrictions)

Question 5

What are symptoms of Bronchiectasis?

Answer 5

Persistent sputum production
Chronic infection
Recurrent "chest infections"
Recurrent antibiotic prescriptions 
No or short-livedresponse to antibiotics 
Chest pain 
Finger clubbing (BUZZ)

Question 6

Which investigations would be performed to diagnose bronchiectasis?

Answer 6

Chest X-ray

HRCT (High-resolution CT)

Question 7

What is important to remember when you have a high clinical suspicion of bronchiectasis but can’t diagnose?

Answer 7

That the sinuses are a reservoir of infection

Question 8

How do you treat bronchiectasis?

Answer 8

Bronchodilators (salbutamol) 
Corticosteroids
Antibiotics (if infection) 
Mucolytic 
Stop smoking 
Postural drainage (twice daily)

Question 9

What features must be present on HRCT to diagnose bronchiectasis?

Answer 9

Bronchioles >1 cm wide

Bronchioles wider than neighbouring arteriole (BUZZ)

Question 10

If a bronchiectasis patient is colonised with bacteria; which antibiotics would be given prophylactically?

Answer 10

Nebulised Gentamicin or colomycin
Alternating Oral antibiotics
Pulse IV abx

Question 11

Which anti-inflammatory treatment reduces exacerbation rates in bronchiectasis?

Answer 11

Low-dose macrolides (Clarithromycin 250 mg OD or Arithromycin 250mg 3/7)