Bronchiectasis

Question 1

What is bronchiectasis ?

Answer 1

irreversible abnormal dilatation of one or more bronchi with chronic inflammation

associated with: chronic cough, viscid sputum production, recurrent chest infections and airflow obstruction

Causes: multiple, though all require an infectious insult

results: impairment of drainage, airway obstruction, and/or defect in host defence

Question 2

what would you see post mortem in the lungs of a bronchiectasis patient?

Answer 2

scarred, thickened walls with mucus in their bronchioles

loss of cilia

Question 3

describe the pathophysiology of bronchiectasis

Answer 3

insult to the airway causes damage (usually infectious)

disordered anatomy

secretion stagnation

secondary infection

ongoing inflammation and further airway damage

Question 4

what is the aetiology of bronchiectasis?

Answer 4

idiopathic in 50% of cases

Cystic fibrosis

post-infective= very common (post TB, pertusis, measles, pneumonia, chickenpox pneumonia )

mucociliary clearance abnormalities

foreign body aspiration

Question 5

can we treat bronchiectasis?

Answer 5

depends on the cause

ex) CF bronchiectasis is not curable, 50% of cases are idiopathic so we cannot treat

Question 6

what are the clinical features of bronchiectasis?

Answer 6

• recurrent ‘chest infections’ or bronchitis
• cough
• chronic sputum production (>50mls)
• intermittent haemoptysis
• dyspnoea
• pleuritic chest pain
• lethargy
• malaise
• weight loss
• clubbing
• dextrocardia (sign of cilliary disorder)
• wheeze
  *

Question 7

What investigations would you order for bronchiectasis?

Answer 7

• CXR - sigmund sign and tram tracking
• HRCT thorax- bronchial wall dilation and thickening
• sputum microbiology - rule out infective cause (aspergillus, pseudomonas)
• pulmonary function tests and reversibility
• immunoglobulin levels (rule out hypoimmunoglobulinaemia)
• genotyping if suspected CF
• alpha one levels

Question 8

how do we manage bronchiectasis?

Answer 8

1. treat the underlying condition
2. physiotherapy/airway clearance techniques
3. reduce bacterial load
4. nutritional support as needed

pharmacotherapy

• beta 2 agonists (short/long acting)
• anti-cholinergics (short/long acting)
• anti-inflammatory= ICS, leukotriene receptor antagonists, NSAIDS (only in CF)
• antibiotics if infectious