Bronchiectasis

Question 1

What is bronchiectectasis?

Answer 1

Chronic dilatation of the airways, leading to chronic infection/inflammation

Question 2

Describe history of a patient with bronchiectectasis

(symptoms and signs)

Answer 2

Symptoms:

• Recurrent cough, producing copious quantities of infected sputum
• Intermittent haemoptysis (can be only symptom)
• Persistant halitosis (bad breath)
• Dyspnoea
• Reccurent febrile episodes and episodes of pneumonia

Signs:

• Clubbing is common (unlike in COPD)
• Coarse inspiratory crackles over infected areas, typically bibasal
• Wheeze
• Often low body habitus due to high energy demands

Question 3

Outline the pathology of bronchiectasis

Answer 3

• Any bronchi may be involved, but most commonly at the lung bases
• Airways are dilated, with purulent secretions and chronic inflammation in the wall with inflammatory granulation tissue
  
  • Granulation tissue can bleed leading to haemoptysis
• With repeated exacerbations there can be fibrous scarring leading to respiratory failure

Question 4

How do the symptoms and signs of brochiectasis differ from COPD?

Answer 4

• Clubbing is common, unlike in COPD.
• Sputum in COPD is not of the same quantity.
• Unlike in COPD, there is no wheeze.

Question 5

What are complications of bronchiectasis?

Answer 5

• Pneumonia
• Pneumothorax
• Empyema
• Lung abcess
• Haematogenous spread of infection
• Severe life threatening haemoptysis: more severe in cystic fibrosis

Question 6

List risk factors for bronchiectasis

Answer 6

Most commonly no cause found, ‘idiopathic bronchiectasis’, however anything that interferes with drainage of brochial secretions or causes recurrent/persistent infection can lead to bronchiectasis:

• Post-infective: TB, measles, pertussis, pneumonia
• Cystic fibrosis
• Bronchial-obstruction: tumour/foreign body
• Allergic broncho-pumonary aspergillosis
• Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
• Immune deficiency: Specific IgA, hypoammaglobulinaemia
• Connective tissue diseases: 1/3rd of RA pts develop bronchiectasis

Question 7

Elicit the physical signs of bronchiectasis

Answer 7

• Production of a khaki coloured, thick, foul-smelling sputum
• Haemoptysis may occur.
• Coarse inspiratory crackles can be heard over infected areas of the lung
• Halitosis (odorous breath) will persist
• Patients will often be febrile
• Clubbing is present.

Question 8

What are the investigations required for a patient with suspected bronchiectasis?

Answer 8

• Sputum culture: atypical organisms
• CXR: cystic shadowing
• CT: to access distribution of disease, can see dilated airways with signet ring sign
• Spirometry: obstructive pattern, reversibility should be assessed