Bronchiectasis Flashcards
Definition
Lung airway disease characterized by bronchial dilation, accumulation of mucus and frequent infections.
Aetiology
Severe inflammation of the bronchi causes fibrosis and dilation of the bronchi.
This is followed by a pooling of mucus, predisposing to further cycles of infection, damage and fibrosis of walls.
Causes include:
• Idiopathic 50%
• Post infective: TB, pneumonia, whooping cough
• Host defects: yellow nail (lymphedema and pleural effusions), Kartagener’s (situs inversus and immobile cilia), CF, Ig deficiency
• Obstruciton of bronchi: swollen lymph nodes, foreign body
• Gastric reflux
• Inflammatory: RA
Epidemiology
Mostly in children, 1/1000 but incidence decreasing with Abio use
Presenting symptoms
Productive cough with purulent sputum or haemoptysis
Breathless, chest pain, dever, weight loss
Symptoms usually begin after an acute respiratory illness.
Signs on physical examination
Clubbing
Basal coarse crepitaitons which move with coughing
Wheeze
Investigations
Sputum: MCS, usually shows Strep pneum, P.aerguinosa, H.influenza S.areus, K, M.catarrhalis, TB.
CXR: dilated bronchi forming tramline shadows, alectasis, pneumotic
consolidations, fibrosis.
High res CT: thickened bronchi, best diagnostic method
Mucociliary clearance studies, sweat electrolytes (CF) and serum Ig.
Management plan
Acute exacerbaitons: two IV antibiotics which are effective against P aerguinosa
Inhaled corticosteroids to reduce inflammation (ie fluticasone) and
bronchodilators for patients with responsive disease
Maintain hydration and physiotherapy, 20 min/d to drain the lobes.
Consider flu vaccination
Bronchial artery embolization with recurrent haemoptysis
Surgical: localized resection, lung of H+L transplant.
Possible complications
Life threatening haemoptysis, life threatening infection, respiratory failure, empyema, cor pulmonale, multi organ abscess
Prognosis
Most patients symptoms persist for 10+ years.
