Bronchiectasis

Question 1

Define Bronchiectasis:

Answer 1

Bronchiectasis is the abnormal and permanent dilation of the bronchi and bronchioles.
The Bronchi can dilate due to severe infection, recurring infections, obstructed bronchus, and destroyed lung tissue. This leads to a build up of excess mucus that can make the lungs more vulnerable to infection.

Question 2

Bronchiectasis: Causes:

Answer 2

Cystic Fibrosis, Childhood Infections, Hypogamma Globulinaemia, ABPA, Immotile Cilia Syndrome, Idiopathic, Ulcerative Colitis.

Question 3

Bronchiectasis: Causative Organisms:

Answer 3

Pseudomonas Aeruginosa
Streptococcus Pneumonia
Staphylococcus Aureus
Haemophilus Influenza

Question 4

Bronchiectasis: Complications:

Answer 4

Pneumonia 
Pleural Effusion
Pneumothorax
Amyloidosis 
Cerebral Abscess.

Question 5

Bronchiectasis: Symptoms:

Answer 5

Breathlessness
Cough
Sputum 
Chest Pain 
Haemoptysis 
Wheeze
Tiredness

Question 6

Bronchiectasis: Signs:

Answer 6

Finger Clubbing
Inspiratory Crepitations - sputum build up
Bronchial Breathing
Cyanosis
When there are secretions or associated lobar collapse, then there wont be any physical signs

Question 7

Bronchiectasis: Investigations:

Answer 7

HRCT Thorax - assess extent of disease
Apergillus Precipitations
Total IgE
Sputum Culture
Serum Immunoglobulins
Spirometrey (obstructive pattern), assess reversibility
CXR - cystic shaddows, thickened bronchial walls.
Bronchoscopy - locate sign of haemoptysis, obtain samples for culture and exclude obstruction.

Question 8

Bronchiectasis: Treatment:

Answer 8

1. Antibiotics - for underlying infection
2. Inhaled Therapy - SABA, ICS (Prednisilone for APBA)
3. Chest Physiotherapy - postural drainage should be performed 2 x day.
4. Surgical Treatment: in localised disease, or to control severe haemoptysis.
   Parallel line shaddows - tram-lines - common in bronchiectasis and indicate dilated bronchi due to peribronchial inflammation and fibrosis.