Bronchiectasis

Question 1

Define:

Answer 1

Lung airway disease characterised by chronic bronchial dilation and impaired mucociliary clearance as well as recurrent bacterial infections

Question 2

Aetiology/risk factors:

Answer 2

Chronic inflammation leads to fibrosis and permanent dilation.

This destroys the elastic and muscle components in the bronchial wall.

pooling of mucus leads to more frequent infections –> more damage.

Question 3

What are causes of Bronchiectasis?

Answer 3

Idiopathic (50%)

Congenital - cystic fibrosis (most common), a1 anti-trypsin deficiency,Young’s syndrome, primary ciliary dyskinesia, Kartagener’s syndrome

Host immunodeficiency - HIV, hypogammaglobulinaemia

Obstruction of the bronchi - tumour, enlarged lymph nodes, foreign body

Post infection - TB, whooping cough, pneumonia, bronchiolitis and measles

Inflammatory disorders - UC, rheumatoid arthritis

ABPA

GORD

Question 4

Epidemiology:

Answer 4

Most cases occur in childhood

decreased incidence since the use of antibiotics

thin, white and tall over 60 year old women are more at risk of non-TB bronchecistasis

1/1000 per year

Question 5

Symptoms:

Answer 5

persistent cough with lots of prulent sputum (worse on lying down)

Intermittent haemoptysis

Fever

Weight loss

malaise

breathlessness

symptoms are worse on exacerbation.

Question 6

Signs:

Answer 6

Coarse crackles at the end of inspiratory phase (shift with coughing)- mainly heard at the lung bases

Clubbing

Wheeze

Question 7

Investigations:

Answer 7

Gold standard is a High resolution CT - shows dilated bronchi with thickened walls

Sputum - culture and sensitivity

CXR - bronchial dilation, pneumonic consolidation, Atelectasis (collapse of part or a whole lung), fibrosis, may be normal

Spirometery -shows obstructive image

bronchoscopy - very rarely done

CF sweat test

Aspergillus skin test

Serum Ig

Question 8

Management:

Answer 8

Postural drainage for sputum and mucus clearance – chest physiotherapy may aid this.

• Treat acute exacerbations with IV ANTIBIOTICS, according to bacterial sensitivities.
• Prophylactic antibiotics should be considered in patients with frequent exacerbations (> 3/year)
• Bronchodilators e.g. nebulised salbutamol - considered in patients with responsive disease e.g. asthma, COPD
• Inhaled Corticosteroids (e.g. fluticasone) - reduces inflammation and volume of sputum – useful for ABPA
• Maintain hydration
• Flu vaccination
• Surgical - localised resection, lung or heart-lung transplantation – may be indicated in localised disease or to control severe haemoptysis
• Bronchial artery embolisation - if life-threatening haemoptysis due to bronchiectasis

Question 9

Complications:

Answer 9

Pneumothorax

respiratory failure

life threatening haemoptysis

persistent infection

empyema

pneumonia

amyloidosis

Cor pulomanale (right sided heart failure due to lung disease)

multi-organ abscesses

Question 10

Prognosis:

Answer 10

most people have symptoms for 10+ years