Bronchiectasis

Question 1

What is the specific diagnostic feature of bronchiectasis?

Answer 1

Broncho-Arterial ratio >1 (when internal diameter of the airway is greater than the accompanying branch of the pulmonary artery)

Perform when not acute exacerbation as bronchial dilatation maybe transient in acute infection

Question 2

Causes?

Answer 2

80% of patients - nil identifiable cause

COPD & Smoking

Post infection: TB, recurrent pneumonia/LRTI’s
Congenital: Cystic Fibrosis, primary ciliary dyskinesia
Immunodeficiency: Primary (hypogammaglobulinemia, HIV) or secondary (methotrexate, transplant patients)

Pulmonary fibrosis, pneumoconiosis

Sarcoidosis, Methotrexate

Post obstruction (with a foreign body)

(Ref: RACGP Graham Macquire article)

Question 3

When to suspect bronchiectasis?

Answer 3

Diagnosed with asthma, but nil improvement with usual treatment

Digital clubbing (not common in copd and asthma)

Lack of significant smoking history

Recurrent and or severe pneumonia

Presence of unusual organisms in the sputum (e.g. Aspergillus, pseudomonas, klebsiella)

Question 4

What is “Traction bronchiectasis” ?

Answer 4

associated with interstitial lung disease

Question 5

Management?

Answer 5

Quit Smoking 
Chest physio 
Pulmonary rehabilitation 
Puffers: SABA, LABA, LAMA 
Vaccination: Influenza and Pneumococcus

Question 6

What is bronchiectasis?

Does it have an effect on mortality?

Answer 6

1. Irreversible bronchial dilatation
   (from chronic recurrent inflammation + abnormal anatomy)
   Long term cough, with purulent sputum and bibasal creps
2. Most commonly, the condition becomes gradually worse over a number of years but in the great majority of patients this does not affect mortality.