Bronchiectasis

Question 1

Define Bronchiectasis?

Answer 1

Lung airway disease characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections

Question 2

What is the aetiology of Bronchiectasis?

Answer 2

Chronic lung inflammation leads to fibrosis and permanent dilation fo the bronchi
This leads to pooling of mucus, whih predisposes to further cycles of infection, damage and fibrosis of bronchial walls

Question 3

What are the causes of Bronchiectasis?

Answer 3

Idiopathic (50%)
Post-infectious (e.g. pneumonia, whooping cough, TB)
Host-defence defects (e.g. Kartagener’s Syndrome, cystic fibrosis)
Obstruction of bronchi (e.g. foreign body, enlarged lymph nodes)
GORD
Inflammatory disorders (e.g. rheumatoid arthritis)

Question 4

What is the epidemiology of Bronchiectasis?

Answer 4

Most often arises initially in CHILDHOOD
Incidence has decreased with the use of antibiotics
1/1000 per year

Question 5

What are the presenting symptoms of Bronchiectasis?

Answer 5

Productive cough with purulent sputum or haemoptysis
Breathlessness
Chest pain
Malaise
Fever
Weight Loss
Symptoms usually begin after an acute respiratory illness

Question 6

What are the signs of Bronchiectasis?

Answer 6

Clubbing
Coarse Crepitations (usually at lung bases) (these shift with coughing)
Wheeze

Question 7

What do we look at in the Sputum for Bronchiectasis?

Answer 7

Culture and sensitivity

Question 8

What are the common organisms we see when we analyse the sputum for Bronchiectasis?

Answer 8

Pseudomonas aeruginosa 
Haemophilus influenzae 
Staphylococcus aureus 
Steptococcus pneumoniae 
Klebsiella 
Mycobacteria

Question 9

What do we see on a CXR for Bronchiectasis?

Answer 9

Dilated bronchi 
Fibrosis 
Atelectasis 
Pneumonic consolidations
May be normal

Question 10

What might Dilated Bronchi be seen as on a CXR?

Answer 10

Parallel lines going from the hilum to the diaphragm (tramline shadows)

Question 11

What is the best diagnositc method for Bronchiectasis?

Answer 11

High-Resolution CT

Question 12

What do we see on a high-resolution CT for Bronchiectasis?

Answer 12

Shows dilated bronchi with thickened walls

Question 13

What are the other investigations we can do for Bronchiectasis?

Answer 13

Bronchography (rarely used)
Swear electrolytes (for cystic fibrosis)
Serum Ig
Mucociliary clearance study

Question 14

How do we treat acute exacerbations of Bronchiectasis?

Answer 14

Two IV antibiotics, which cover Pseudomonas aeruginosa

Question 15

When should prophylactic antibiotics be considered for Bronchiectasis?

Answer 15

In patients with frequent exacerbations (>3/year)

Question 16

What are the other things involved in a management plan of Bronchiectasis?

Answer 16

Inhaled Corticosteroids 
Bronchodilators 
Maintain hydration
Flu vaccination
Physiotherapy 
Bronchial Artery Embolisation

Question 17

What do Inhaled Corticosteroids do for Bronchiectasis?

Answer 17

Reduces inflammation and volume of sputum but doesn’t affect the frequency of exacerbations or lung function

Question 18

When are Bronchodilators considered for Bronchiectasis?

Answer 18

In patients with responsive disease

Question 19

Why do we give Physiotherapy for Bronchiectasis?

Answer 19

Enables sputum and mucus lerance

This can reduce frequency of acute exacerbations and aid recovery

Question 20

When do we do Bronchial Artery Embolism for Bronchiectasis?

Answer 20

If life-thereatening haemptysis due to bronchiectasis

Question 21

What is the surgical management plan for Bronchiectasis?

Answer 21

Localised resection

Lung or heart-lung transplantation

Question 22

What are the possible complications of Bronchiectasis?

Answer 22

Life-threatening haemoptysis 
Persistent infections
Empyema 
Respiratory failure 
Cor pulmonale 
Multi-organ abscesses

Question 23

What is the prognosis for patients with Bronchiectasis?

Answer 23

Most patients continue to have symptoms after 10 yrs