Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of the airways.

Question 2

What are causes of bronchiectasis?

Answer 2

Congenital: Cystic fibrosis,
Post-infection: TB, measles, pertussis (whopping cough), pneumonia, bronchitis, HIV
Malignant - bronchial obstruction
Foreign body - bronchial obstruction
Allergic bronchopulmonary aspergillosis
Immune deficiency

Question 3

What are symptoms of bronchiectasis?

Answer 3

Persistent cough
Copious purulent sputum
Intermittent haemoptysis

Question 4

What are sings of bronchiectasis?

Answer 4

Clubbing
Coarse inspiratory crepitation
Wheeze

Question 5

What is seen on X-ray? CT?

Answer 5

Cystic shadows
Thickened bronchial walls - tramline and sign shadows
Abnormal dilatation of airways

HRCT - tram track and signed ting signs - assess extent and distribution

Question 6

What would you find on spirometry in bronchiectasis?

Answer 6

Obstructive pattern
FEV1<80% predicted
FVC = normal or low
FEV1:FVC < 70% predicted

Much shallower gradient and lower max on spirogram

Question 7

What is spirometry? Normal values? Obstructive/restrictive?

Answer 7

Measures functional volumes:
Forced expiratory volume in 1s FEV1
Forced vital capacity FVC
Full forced expiration into a spirometer, exhalation continues until no more breath can be exhaled.

FEV1:FVC ratio give estimate of severity of airflow obstruction.

Normal:
FEV1 > 80% predicted
FVC > 80% predicted
FEV1:FVC 75-80%

Restrictive 
FEV1 < 80% predicted
FVC < 80% predicted
FEV1:FVC > 70% normal
(ILD, fibrosis, sarcoidosis, CT disease, pleural effusion, pneumoconiosis, obesity)

Obstructive
FEV1 < 80% predicted
FVC: normal or low
FEV1:FVC < 70% predicted
(COPD, asthma, bronchiectasis, CF)

Question 8

What tests for bronchiectasis?

Answer 8

Bedside
Bloods
Imaging: CXR, HRCT chest
Special: Spirometry, bronchoscopy to locate size of haemoptysis, exclude obstruction and samples for cultuure
Serum immunoglobulins, CF test

Question 9

What is the management of bronchiectasis?

Answer 9

Physical training of airway clearance techniques
Mucolytics
Chest physiology may aid sputum expectoration and dainage

Antibiotics for exacerbation

Pseudomonas will require oral ciprofloxacin

Bronchodilators (e.g. neb salbutamol_ may be useful if asthma, COPD, CF

Corticosteroids

Surgery in localised disease or to control severe haemoptysis.

Question 10

What are the most common organisms isolated from patients with bronchiectasis?

Answer 10

Haemophilus influenzae
Stroptococcus pneumonia
Pseudomonas aeruginosa
Staphylococcus aureus

Question 11

What are complications of bronchiectasis?

Answer 11

Pneumonia
Pleural effusion
Pneumothorax
Haemoptysis
Cerebreal abscess