Bronchiectasis Flashcards
what is it
permanent dilatation of the airways due to chronic infection of bronchi and bronchioles
What are the causes?
- Post infection - pneumonia, TB, measles, whooping cough
- Congenital - CF, primary ciliary dyskinesia
- Mechanical bronchial wall obstruction - foreign body, post TB stenosis, LN, tumour
Explain the pathophysiology of bronchiectasis
failure of mucociliary clearance and impaired immune function -> continued insult to bronchial wall
Bronchitis -> bronchiectasis -> fibrosis
airways dilate due to pulm inflammation and scarring as fibrosis contracts
How does it tend to present?
- Chronic cough w copious amounts of foul smelling purulent sputum (sometimes flecked w blood)
- Dyspnoea
- Wheeze
- Recurrent infections - fever, chest pain
What is found on examination?
Crackles on auscultation
Which lobes are usually affected?
lower lobes
What investigations would u do?
- CXR - normal, tramline + ring shadows
- High resolution CT - thickened dilated airways
- FBC - neutrophilia suggests infection/exacerbation
- Sputum culture
- Sweat chloride test - CF
- Rheumatoid factor (RA)
What is involved in the non-pharmacological management ?
exercise (also helps mucus clearance)
pulmonary rehabilitation
airway clearance therapy
What is involved in pulmonary rehabilitation?
8 week training programme to improve exercise and endurance capacity
What is involved in airway clearance therapy?
postural drainage
percussion
vibration
use of oscillatory devices
What is the pharmacological management?
Bronchodilators (if concurrent asthma/COPD)
Antibiotics for exacerbations
What is seen on spirometry
obstructive pattern
What antibiotics are usually given for exacerbations?
H influenza, s pneumoniae - amoxicillin
Pseudomonas aeruginosa - ciprofloxacin
What organisms are usually the culprit of infective exacerbations?
H. influenzae
Psuedomonas aeruginosa
Klebsiella
Strep pneumoniae
When is surgery indicated?
localised disease
to control severe haemoptysis
