Bronchiectasis

Question 1

What is Bronchiectasis?

List 4 things its associated with

Answer 1

Irreversible dilation of 1/more Bronchi (poor mucus clearance)

• Chronic cough
• Sputum production (may be purulent)
• Bacterial colonisation
• Recurrent infection

Question 2

There a variety of causes of Bronchiectasis, and common to them all is Chronic Inflammation.

How does this cause enlarged airways?

Answer 2

Destruction of elastic and muscular components of bronchial wall + perichondrial fibrosis

Question 3

How does Bronchiectasis look on a CXR?

Answer 3

• Dilated Bronchi with thickened walls (Tram-Track Sign)

- May be normal in early disease

Question 4

What is the gold standard diagnostic test for Bronchiectasis?

How does this look?

Answer 4

• High resolution CT
• Bronchial dilation > than adjacect blood vessel
• Bronchial wall thickening

Question 5

Bronchiectasis also appears with the Signet Ring sign.

What is this?

Answer 5

Bronchus diameter > Pulmonary artery

Question 6

List 8 signs and symptoms of Bronchiectasis

Answer 6

• Hypoxaemia (advanced cases)
• Fever
• Haemoptysis (50% of cases)
• Systemic signs (weight loss)
• Clubbing of fingers
• Fine crackles (rales)
• High pitched inspiratory squeaks
• Rhonchi

Question 7

List 2 Infective causes and 1 Immune Deficiency-related cause of Bronchiectasis

Answer 7

Infective - Whooping cough and TB

Immune deficiency - Hypogammaglobulinaemia

Question 8

List 5 Genetic/ Mucociliary Clearance Defects that can cause Bronchiectasis

Answer 8

• Cystic Fibrosis
• Alpha 1 Antitrypsin deficiency
• Primary Ciliary Dyskinesia
• Young’s Syndrome (Triad of Bronchiectasis, Sinusitis, Reduced Fertility)
• Kartagener’s Syndrome (Triad of Bronchiectasis, Sinusitis, Situs Invertus)
• Yellow Nail Syndrome (Triad of Yellow Nails, Pulmonary manifestations, Lower Limb Lymphoedema)

Question 9

Bronchoectasis can also be caused by Obstruction.

List 3 causes of this

Answer 9

Forgin body
Tumour
Extrinsic Lymph Node

Question 10

List 6 organisms that commonly cause Bronchiectasis

Answer 10

• H. influenzae
• Pseudomonas aeurginosa
• M. Catarrhalis
• S. maltophilia
• Mycobacteria tuberculosis
• Aspergillus and Candida (FUNGI)

Question 11

How can PFTs appear in Bronchiectasis?

Answer 11

• FEV1/ FVC <0.7
• Possible RV/ TLC elevation (air trapping)
• Possiblly reduced DLCO in severe disease

Question 12

How may sputum differ in Chronic Bronchitis and Bronchiectasis

Answer 12

Chronic Bronchitis:
- White

Bronchiectasis:

• Foul smelling
• Purulent

Question 13

How can we manage Bronchiectasis?

Answer 13

• Physio/ Airway clearance (daily or more often)
• Antibiotics for Acute Exacerbations
• Vaccinations (Flu and Strep pneumoniae)
• Treat underlying cause if possible

Question 14

How do we define an Acute Exacerbation of Bronchiectasis?

Answer 14

A person with Bronchiectasis with deterioration in 3/more symptoms for at least 48 hours;

• Cough
• Sputum volume/ consistency
• Sputum purulence
• Fatigue
• Dyspnea
• Haemoptysis