Bronchiectasis

Question 1

what are the causes of bronchiectasis? (9)

Answer 1

things that cause bronchial obstruction
Cystic fibrosis 
Bordetella Pertussis infections
Aspergillus 
Cilary dysfunction syndromes
Primary hypogammaglobinaemia
Congenital abnormalities
TB
Tumour + foreign bodies
RA, UC, idiopathic

Question 2

What are the clinical features of bronchiectasis?

Answer 2

Chronic Coughing
Wheezing
SOB
Foul smelling mucus, contain blood – worse in the morning
Intermittent Haemoptysis
Digital Clubbing
Advanced – weight loss, anorexia, low grade fever, failure to thrive

Question 3

what auscultation signs will be present in bronchiectasis?

Answer 3

bi lateral or unilateral
Coarse crackles
Possible collapse
Reduced or absent breath sounds at areas distal to places of obstruction

Question 4

What investigations should be done for bronchiectasis diagnosis?

Answer 4

Sputum sample
Xray
CT
PFT
Genotyping
CF sweat test
measure mucocillary clearance

Question 5

what bacteria is commonly found in sputum cultures of bronchiectasis?

Answer 5

pseudomonas aeruginosa, H influenzae, staph aureus, aspergillus fumigates, fungi (e.g. Aspergillus) and various mycobacteria

Question 6

What 2 mechanisms cause bronchiectasis?

Answer 6

Obstruction

Chronic inflammation

Question 7

what is the mechanism behind obstruction in bronchiectasis?

Answer 7

Obstruction by mucus
primary ciliary dyskinesia – cillary doesn’t move properly and mucus remains stuck in airways
bacteria gets caught in mucus and multiplies

Question 8

what is the mechanism behind chronic inflammation in bronchiectasis?

Answer 8

over time immune cells and there cytokines actually damage ciliated epithelial cells, destroy elastin fibres
Over time airways become dilated and filled with mucus
Fibroblasts try to fix damage by replacing elastin with collagen – stiff, airways can’t move properly = obstructive
Dilate as scar tissue contracts

Question 9

what features will be present in an xray of bronchiectasis?

Answer 9

normal, in advanced disease you may be able to see areas of thickened airway walls, cystic spaces, and consolidation or collapse.

Question 10

what is the management of bronchiectasis?

Answer 10

Antibiotics for treatment of recurrent pneumonia - >3 exacerbations consider prophylaxis 
Postural drainage – remove mucus 
Steroids 
Bronchodilators 
Surgery 
Flu vaccine

Question 11

what are the complications of bronchiectasis?

Answer 11

Empyema
Pulmonary fibrosis
Cor pulmonale
Metastatic abscesses e.g. in the brain
Amyloid formation
Massive haemoptysis