Bronchiectasis Flashcards
What is bronchiectasis?
Chronic inflammation of the bronchi and bronchioles leading to permanent dilatation and thinning of these airways. Permanent dilation usually secondary to infection/ inflammation.
Name some “infective” causes of bronchiectasis
TB, Measles, pertussis, pneumonia, HIV
Name some other causes of bronchiectasis
Congenital- cystic fibrosis
Ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
Yellow nail syndrome
Bronchiole obstruction e.g. lung cancer/ foreign body
Immune deficiency- selective IgA, hypogammaglobulinemia
Rheumatoid arthritis
Ulcerative colitis
What are the symptoms of bronchiectasis
- Persistent cough
- Copious purulent sputum
- Intermittent haemoptysis
- Wheezing (asthma, COPD, ABPA)
- Foul smelling mucus
What signs would you look out for O/E?
Name some investigations you would like to do
- Sputum culture
- CXR
- HRCT (high-resolution CT)
- Spirometry
5.
What will you look out for on CXR?
- Cystic shadow
- Thickened bronchial walls (tramline and ring shadows)
What will you see on the HRCT?
You can assess the distribution of disease.
You will see the tram-track pattern and signet ring signs
What will you see on the spirometry test?
An OBSTRUCTIVE pattern
FEV1 is decreased
FEV1/FVC ratio is also decreased
Name some common organisms isolated from patients with bronchiectasis
Outline management plan
- Physical training (inspiratory muscle training)- good evidence base for patients with non-cystic fibrosis bronchiectasis
- Airway clearance techniques and mucolytics- chest physiotherapy and devices such as flutter valve
- Antibiotics for exacerbations and long term rotating antibiotics in severe cases
- Bronchodilators in selected cases (patients with asthma/ COPD)
- Corticosteroids (e.g. prednisolone and itraconazole for ABPA
- Surgery in selected cases (e.g. localised disease)
