BRONCHIECTASIS

Question 1

Define bronchiectasis

Answer 1

Chronic infection of the bronchi and bronchioles leading to permanent dilatation of the airways. The airways become filled with mucus which can lead to an obstructive pattern.

Question 2

What are the main organisms that can cause the chronic infections in bronchiectasis?

Answer 2

H. influenzae
S. pneumoniae
S. aureus
P. aeruginosa

Question 3

What are the congenital causes of bronchiectasis?

Answer 3

Cystic fibrosis
Young’s syndrome
Primary ciliary dyskinesia (approx half of these patients will have Kartagener’s syndrome)

Question 4

What would a patient with suspected bronchiectasis typically present with? (Name 3 symptoms)

Answer 4

Persistent cough
Copious purulent sputum
Intermittent haemoptysis

Question 5

What signs would typically be detected in a patient with suspected bronchiectasis? (Name 3 possible signs)

Answer 5

Finger clubbing
Coarse inspiratory crepitations
Wheeze

Question 6

What might be seen on x-ray of a patient with bronchiectasis?

Answer 6

Marked abnormal dilatation of the airways
This may be in one lobe or widespread
There may be cystic shadows, indicating that this patient may have cystic fibrosis

Question 7

What tests and investigations would be ordered to confirm a diagnosis of bronchiectasis?

Answer 7

Chest X-ray
CT scan or even High Resolution CT (HRCT)
Sputum culture
Spirometry - often shows an obstructive pattern
Bronchoscopy - locate site of haemoptysis

Question 8

What are the management options for a patient with confirmed bronchiectasis?

Answer 8

Postural drainage - literally inclining the body so that the trachea is below the affected lobe to clear the airway. This should be accompanied by chest physiotherapy.

Antibiotics - prescribed according to bacterial sensitivities.

Bronchodilators - useful in patient with co-morbidities such as asthma, COPD and Allergic Bronchopulmonary Aspergillos (ABPA)

Corticosteroids eg prednisolone - for patients with ABPA

Question 9

What are the possible complications of bronchiectasis? (Name at least 3)

Answer 9

Pnuemonia
Pleural effusion
Pneumothorax
Haemoptysis
Cerebral abscess
Amyloidosis

Question 10

What are the non-congenital causes of bronchiectasis? (Name at least 4)

Answer 10

Post-infection
Bronchial Obstruction 
Allergic Bronchopulmonary Aspergillos (ABPA)
Hypogammaglobulinaemia
Rheumatoid Arthritis (RA)
Ulcerative colitis
Idiopathic