Bronchiectasis Flashcards
What is bronchiectasis?
Bronchiectasis is the permanent dilation of bronchi due to the destruction of the elastic and muscular components of the bronchial wall.
What are the risk factors of bronchiectasis?
CF Immunodeficiency Previous infection Congenital Primary ciliary dyskinesia Measles, tb, whooping cough
Alpha 1 antitrypsin deficiency, connective tissue disease, IBD, aspiration or inhalation injury, focal bronchial obstruction, (tall, thin, white females over 60), thyroiditis
What are the signs and symptoms of bronchiectasis?
Cough SOB Sputum (lots of foul smelling) Fatigue Haemoptysis Rhinosinusitis Weight loss Wheezing Pleuritic chest pain Crackles (mid or early Dyspnoea Fever Clubbing
What is the epidemiology of bronchiectasis?
Prevalence may be increasing worldwide
More common in older people
Incidence = 1-2 per 100,000
What are the investigations for bronchiectasis?
CXR
Normal or obscured hemidiaphragm
Thin walled ring shadows with ot without fluid levels, tram lines, tubular or ovoid opacities
Signet ring
High-resolution chest CT
Thickened dilated airways with ot without air fluid levels, varicose constrictions along airways
FBC
High eosinophil count
Bronchopulmonary aspergillosis
Neutrophilia
sputum culture and sensitivity
G+ve/G-ve/non TB Mycobacteria/ fungi
serum alpha-1 antitrypsin phenotype and level
May be abnormal
serum immunoglobulins
Decreased IgG, IgM or IgA
sweat chloride test
High or low
rheumatoid factor
May be positive
Aspergillus fumigatus skin prick test
serum HIV antibody
nasal nitric oxide (NNO)
pulmonary function tests
What are the complications of bronchiectasis?
Massive haemoptysis > Breathing and circulation support > Interventional radiologist Respiratory failure > Airway protection Cor pulmonale > May require transplantation Brain abscess Amyloidosis Pneumonia, sinusitis
What is the management of bronchiectasis?
Exercise and improved nutrition Airway clearance therapy Inhaled bronchodilator Inhaled hyperosmolar agent Long term oral macrolide Inhaled antibiotic Short term oral antibiotic IV antibiotics Surgery Non invasive ventilation Supplemental oxygen
What is the prognosis of bronchiectasis?
Irreversible Symptom control and exacerbations Severity index Quality of life may be affected 19% after 14 yrs
