Bronchiectasis Flashcards
What is bronchiectasis?
Abnormal & permanently dilated airways leading to build up of excess mucus meaning lungs are more vulnerable to infection
Features of bronchiectasis?
Neutrophilic inflammation
Recurrent infection
Damage to airways
Impaired clearance of secretions
Causes?
Granuloma (TB, sarcoidosis)
Post infective bronchial damage e.g. pneumonia
Mechanical bronchial obstruction (intrinsic, extrinsic)
Immunological over response (allergic bronchopulmonary aspergillosis)
Presentation?
Persistent cough Breathlessness Recurrent chest infections Sputum production Haemoptysis Recurrent antibiotic prescriptions Signet ring sign Coarse crackles Pleuritic chest pain
Investigations?
HRCT scanning CXR Sputum examination Immune assessment Sweat test Nasal nitric oxide Total IgE and aspergillum specific IgE skin prick testing
HRCT scanning?
Most accurate for diagnosis Increased bronchoarterial ratio? Bronchus visualised within 1cm of pleural space Tram track airways Signet ring sign
Sweat test?
Used to rule out cystic fibrosis - CF will have high salt levels
CF can often be cause of bronchiectasis
Management?
Airway clearance
Anti-inflammatories
Treat infection - antibiotics
Treat complications
Bronchodilators Corticosteroid therapy Dietary supplementation Oxygen Hospitalization for severe exacerbations Surgical therapies
Complications?
Recurrent pneumonia Empyema
Lung abscess
Progressive respiratory failure, and cor pulmonale. Chronic bronchial infection, and pneumothorax.
Life-threatening hemoptysis may occur but is uncommon.
Upper lobe bronchiectasis?
CF
TB
Middle lobe?
Immotile cilia syndrome
Myobacterium avid complex
Lower lobe?
Interstitial LD
PID
Recurrent aspiration (alcoholic)
