Bronchiectasis Flashcards
What does ectasis mean?
If you know what ectasis means, what does bronchiectasis mean?
Persistent dilatation (ectasis) - due to damage from infection and inflammation
Chronic inflammation of bronchi and bronchioles leading to permanent dilatation and thickening of these airways
Why can recurrent infections develop?
Causative pathogens - 2
Inflamed, thick-walled, collapsible airways
Reduce the flow of air and mucous
Causing airway obstruction and creating a stagnant pool
H. influenzae
Strep pneumoniae
What may occur in childhood that could lead to bronchiectasis?
Main genetic cause?
Alpha-1-antitrypsin deficiency (AATD) can cause this. What is it?
After what lung infections can this occur?
Allergic bronchopulmonary aspergillosis (ABPA) is an allergic cause. What is this?
Autoimmune - 1
Frequent and/or severe childhood lung infections
CF
If you have a low level of AAT, the surrounding lung isn’t protected as well as it should be. So when you breathe in smoke or have a lung infection, the enzymes will cause much more damage to the surrounding healthy lung. This can lead to the development of chronic obstructive pulmonary disease (COPD). It’s especially damaging to the small air spaces (alveoli) where oxygen and carbon dioxide are exchanged – these become bigger leaving holes referred to as emphysema.
Measles Bronchiolitis Pneumonia TB HIV
Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic or hypersensitive reaction to a fungus known as Aspergillus fumigatus. This is a fungi found in the soil.
Although most of us are frequently exposed to Aspergillus, a reaction to it is rare in people with normal immune systems. However, in certain people, the immune system overreacts to the antigens of Aspergillus fumigatus found in the lungs. This may damage the airways and result in permanent lung damage.
Rheumatoid Arthritis
SUMMARY OF EVERYTHING
Congenital (cystic fibrosis, primary ciliary dyskinesia i.e. Kartagener syn)
Acquired (pneumonia, allergic bronchopulmonary aspergillosis)
Symptoms:
A persistent cough is the main symptom. What is the colour of the sputum?
What tends to be intermittent?
Signs:
Types of crackles heard on auscultation?
When during the breathing cycle is it heard?
What other added sounds are heard? - 1
Hands sign of low chronic lung disease?
Green/yellow - sometimes specks of blood
Coarse
Early-inspiratory
Wheeze
Clubbing
Imaging:
Bloods:
- Why do you do FBC?
- Why do you do RBC?
- Why might you look at eosinophils?
- Why do you do CRP?
Imaging:
- What is the name given for the thickened bronchial walls seen on CXR?
- It is difficult to diagnose it with a simple CXR. What is used for diagnosis instead?
WBC raised in infection
RBC raised in hypoxaemia - V/Q mismatch - look up
Aspergillosis
Tramlines - reflects the absence of normal bronchial tapering)
High-resolution CT
Imaging - High-resolution CT:
What does the tram-track sign suggest?
Where should you look for these?
What does the tree-in-bud sign suggest?
What does the signet ring sign suggest?
Thick-walled bronchioles - towards the edge of the lungs - they can also come in a pair
Mucus plugging
Thick-walled, dilated bronchus - usually next to the pulmonary vessel
https://www.radiologycafe.com/medical-students/radiology-basics/chest-pathology
Lung tests:
Spirometry - What happens to the FEV1/FVC ratio and why?
When is bronchoscopy done?
Reduced due to obstructive pattern
For suspected foreign body inhalation or obstruction
Investigations for causes of bronchiectasis:
Why is done for alpha-1-antitrypsin deficiency (AATD)?
What is done for CF?
How can you test for immunodeficiency?
What virus can you test for?
Why do you measure rheumatoid factor?
Serum alpha-1 antitrypsin
CF sweat test
Immunoglobulin levels
HIV test
People with RA can develop disease in their lungs, as a consequence of their immune system attacking their joints and other tissues. Different types of lung disease can occur, including interstitial lung disease (ILD), bronchiectasis and bronchiolitis obliterans.
Investigations for causes of bronchiectasis:
What is done to look for allergic bronchopulmonary aspergillosis (ABPA)?
What is done for chronic aspiration suspected?
Ciliary function only tested if no other cause is found and/or there have been chronic issues since childhood.
What is done to check for primary ciliary dyskinesia?
Aspergillus IgE and skin prick testing
Exhaled nasal nitric oxide - low in PCD
Monitoring:
How often are pulmonary function tests done?
Why do you do regular sputum MC+S?
Annually
Checking changing sensitivities of bacteria
Management:
General measures:
- Lifestyle - 1
- What vaccines could they get? - 2
- What type of rehab might patient get?
Smoking cessation
Flu and pneumococcal vaccines
Pulmonary rehabilitation
Management - Specific Treatment:
Therapeutic antibiotics:
- What should be tested before starting each course?
- What AB should be prescribed for pseudomonas? - C
Prophylactic antibiotics:
- How many exacerbations would a patient have before prescribing long term ABs?
- In who are the ABs nebulised?
MC+S so ABs specific
3 or more exacerbations
Nebulised in children and adults colonised with Pseudomonas
Management - Sputum Clearance:
Chest physiotherapy for sputum clearance:
- How long is the physio done?
- How many times a day?
Postural drainage - what is it?
How does nebulised hypertonic saline aid sputum clearance?
30 minutes
3 times a day
A way to use gravity to drain mucus out of your lungs by changing positions
It increases its hydration - use bronchodilators before giving as it can cause chest tightness
Management - Other Medical Options:
Inhaled bronchodilators:
- What type of patient is this particularly useful in?
- Name some? - 2
What is done for a patient with respiratory failure?
What steroids can be given?
Those with reversibility
Nebulised salbutamol
Ipratropium PRN
Tiotropium
O2 therapy or NIV
Prednisolone or itraconazole
Management - Surgery:
What can be done surgically?
What is the final option if the FEV1 is <30% predicted?
Resection of affected lobe or lung in refractory disease confined to a specific area
Lung transplant
