Bronchiectasis Flashcards
define bronchiectasis
Lung airway disease characterized by chronic bronchial dilation, impaired mucuociliary clearance and frequent bacterial infections.
aeitiology of bronchiectasis
severe inflammation of bronchi and bronchioles = fibrosis and dilation and thinning
followed by pooling of mucus, predisposing to further cycles of infection, damage and fibrosis to bronchial walls
causes:
- idiopathic 50%
- post-infectious - After severe pneumonia, whooping cough, tuberculosis, measles, pertussis, bronchiolitis, HIV. - H. influenzae; Strep. pneumoniae; Staph. aureus; Pseudomonas aeruginosa.
- Host defence defects: e.g. Kartagener’s syndrome, cystic fibrosis, immunoglobulin deficiency, yellow-nail syndrome, Young’s syndrome, primary ciliary dyskinesia
- obstruction of bronchi - foreign body, enlarged lymph nodes, tumour
- Congenital/Hereditary: Cystic fibrosis, Ciliary dyskinesia, Marfan’s syndrome, alpha1-antitrypsin deficiency
- inhalation/aspiration
- allergic bronchopulmonary aspergillosis
- pul fibrosis
- gastric reflux disease
- inflamm disorders - rheumatoid arthritis, UC
- immunodeficiency states - AIDS usually as a result of recurrent infection
- hypogammaglobulinaemia
- sarcoidosis
- bronchiolitis obliterans
epidemiology of bronchiectasis
Most often arises initially in childhood, incidence has reduced with use of antibiotics, approximately 1 in 1000 per year.
presenting symptoms of bronchiectisis
cough with purulent sputum or haemoptysis
SOB
chest pain
malaise
fever
weight loss
symptoms usually begin after acute resp distress
signs of bronchiectasis
finger clubbing
coarse inspiratory crepitations (usually at bases), shift with coughing
wheeze - asthma, COPD, ABPA
investigations for bronchiectasis
sputum
- culture and sensitivity
- common organisms: Pseudomonas aeruginosa, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella, Moraxella catarrhalis, Mycobacteria.
CXR
- dilated bronchi (thickened bronchial walls) seen as parallel lines from hilum to diaphragm (tramline shadows)
- fibrosis
- atelectasis
- pneumonic consolidations
- may be normal
- cystic shadows
high resolution CT chest
- dilated bronchi with thick walls
- best diagnostic method
bronchoscopy
- locate site of haemoptysis
- exclude obstruction
- obtain samples for culture
bronchography (rarely used)
- determine extent of disease before surgery
- radio-opaque contrast injected through the cricoid ligament or via a bronchoscope).
sweat electrolytes
serum Ig - 10% adults have some immune deficiency
sinus XR - 30% have concomitant rhinosinusitis
mucociliary clearance study
Aspergillus precipitins or skin-prick test RAST and total IgE.
spirometry
- obstructive pattern
- reversibility should be assessed
CXR changes with bronchiectasis
thickened bronchial walls
ring shadows - thickened airways seen end on
volume loss due to mucus plugging
air fluid levels may be visible in dilated bronchi
bronchiectasis management
acute exacerbations
- 2 IV AB or oral ciprofloxacin with efficacy for pseudomonas
- prophylactic course of AB (oral or aerosolized) for those with frequent >3/yr exacerbations
inhaled corticosteroids eg fluticasone
- reduce inflammation and volume of sputum
- doesnt affect freq of exacerbations or lung function
- bronchodilators - considered in pts with responsive disease
- for ABPA
bronchodilators
- eg nebulised salbutamol
- useful in pts with asthma, COPD, CF, ABPA
maintain hydration - adequate oral intake
consider flu vaccine
physio
- Cornerstone of management is sputum and mucus clearance techniques (e.g.postural drainage).
- shown how to position themselves so lobe to be drained is uppermost
- for 20mins twice daily
- reduce freq of acute exacerbations and aids recovery
flutter valve may aid sputum expectoration and mucus drainage
mucolytics
bronchial artery embolisation - life threatening haemoptysis due to bronchiectasis
surgical for localised disease or haemoptysis - localized resection, lung or heart–lung transplantation.
complications of bronchiectasis
life threatening haemoptysis
persistent infections
pneumonia
pleural effusion
pneumothorax
empyema
respiratory failure
cor pulmonale
multi-organ abscesses (cerebral)
amyloidosis
prognosis for pts with bronchiectasis
Most patients continue to have the symptoms after 10 years.
