Bronchiectasis

Question 1

Bronchiectasis?

Answer 1

Lung airway disease characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections. Chronic lung inflammation leads to fibrosis and permanent dilation of the bronchi this leads to pooling of mucus, which predisposes to further cycles of infection, damage and fibrosis of bronchial walls.

Question 2

Bronchiectasis causes?

Answer 2

Idiopathic (50%)

Post-infectious (e.g. pneumonia, whooping cough, TB)

Host-defence defects (e.g. Kartagener’s syndrome, cystic fibrosis)

Obstruction of bronchi (e.g. foreign body, enlarged lymph nodes)

GORD

Inflammatory disorders (e.g. rheumatoid arthritis)

Question 3

Bronchiectasis epidemiology?

Answer 3

Most often arises initially in CHILDHOOD Incidence has decreased with the use of antibiotics 1/1000 per year.

Question 4

Bronchiectasis symptoms?

Answer 4

Productive cough with purulent sputum or haemoptysis, breathlessness, chest pain, malaise, fever, weight loss, symptoms usually begin after an acute respiratory illness.

Question 5

Bronchiectasis signs (3)?

Answer 5

clubbing, coarse crepitations, wheeze.

Question 6

Bronchiectasis investigations?

Answer 6

Sputum culture, CXR, high res CT.

Question 7

Bronchiectasis CXR?

Answer 7

Dilated bronchi (may be seen as parallel lines going from the hilum to the diaphragm (tramline shadows)) Fibrosis Atelectasis Pneumonic consolidations May be NORMAL

Question 8

Bronchiectasis high res CT?

Answer 8

Shows dilated bronchi with thickened walls. Best diagnostic tool

Question 9

Bronchiectasis management?

Answer 9

treat acute exacerbations with 2 IV antibiotics (prophylactic antibiotics in patients with frequent exacerbations) inhaled corticosteroids, bronchodilators, maintain hydration, flu vaccination, physio.

Question 10

Bronchiectasis complications (6)?

Answer 10

Life-threatening haemoptysis, persistent infections, empyema, respiratory failure, Cor pulmonale, multi-organ abscesses.