Bronchiectasis Flashcards
What is bronchiectasis?
permanent dilation of the airway secondary to infection or inflammation
What is the aetiology of bronchiectasis?
Severe inflammation in lung causes fibrosis + dilation of the bronchi.
Followed by pooling of mucus, predisposing to further cycles of infection, damage + fibrosis to bronchial walls.
What is the most common cause of bronchiectasis?
Severe lower Respiratory tract infection:
pneumonia
pertussis
pulmonary TB
mycoplasma
influenza
List 7 causes of bronchiectasis
Post-infectious: TB, measles, pertussis, pneumonia
Cystic fibrosis
Bronchial obstruction: lung cancer/ FB
Immune deficiency: selective IgA, hypogammaglobulinaemia
ABPA
Ciliary dyskinetic syndromes: Kartagener’s + Young’s
Yellow nail syndrome
What chronic inflammatory conditions are associated with bronchiectasis?
CTDs: RhA
IBD: UC > Crohns
List 3 symptoms of bronchiectasis
Productive cough with large vol purulent sputum >8w
Dyspnoea
Haemoptysis
List 3 signs of bronchiectasis
Finger clubbing
Coarse creptitations (early inspiration, at bases, shift with coughing)
Wheeze.
What initial investigations should you perform for bronchiectasis?
Sputum culture: ID colonising pathogens
CXR: r/o other pathology
Spirometry: assess severity of airflow obstruction
O2 Sats
FBC
+ refer to a resp consultant
What investigations for bronchiectasis are performed in secondary care?
High resolution CT: diagnostic
Ix for underlying cause: sweat test (CF), Ab deficiency, PCD
List 4 common organisms isolated from patients with bronchiectasis
Haemophilus influenzae (most common)
Pseudomonas aeruginosa
Klebsiella spp.
Streptococcus pneumoniae
What is seen on CXR in bronchiectasis?
Dilated non-tapering bronchi: parallel lines radiating from hilum (tram tracks).
Ring shadow: bronchi end on +/- fluid levels
Increase in bronchovascular markings
What is seen on high res. CT in bronchiectasis?
Dilated bronchi with increased bronchoarterial ratio: Signet ring sign (vertically oriented bronchi)
Lack of tapering
Visibility of peripheral airways within 1cm of costal pleura
Describe conservative management of bronchiectasis
Exercise (form of airway clearance) + improved nutrition
Airway clearance therapy with respiratory PT
Smoking cessation advice
What does airway clearance therapy involve?
Maintenance of oral hydration
Percussion, breathing or coughing strategies
Positioning + postural drainage
Positive expiratory pressure devices + oscillatory devices
What medical management may be used in bronchiectasis?
Bronchodilator (Salbutamol) if asthma-type response
Mucoactive agent: nebulised hypertonic saline, promotes clearing by inducing coughing
What vaccinations are offered to patients with bronchiectasis?
Pneumococcal
Influenza: Annually
List 6 complications of bronchiectasis
Life-threatening haemoptysis Persistent infections Empyema Respiratory failure Cor pulmonale Multi-organ abscesses.
How does an acute exacerbation of bronchiectasis present?
Worsening of cough
Change in sputum colour
Increase in sputum volume
Fever +/or Malaise
Which antibiotic is used against pseudomonas aeruginosa and Klebsiella in an acute exacerbation of bronchiectasis?
Ciprofloxacin
If previous micro cultures are unknown, which antibiotic is used in an acute exacerbation of bronchiectasis?
Amoxicillin
(If pen allergic Clarithromycin or Doxycycline)
In patients at higher risk of treatment failure in an acute exacerbation of bronchiectasis, what antibiotic should be used instead of amoxicillin?
Co-amoxiclav
When is surgery used in bronchiectasis?
Localised disease + Sx not controlled by optimal medical Mx
OR
Massive haemoptysis
Which antibiotic may be used for long term prophylaxis in bronchiectasis? When is this indicated?
Azithromycin
if 3 or more exacerbations per year despite maintenance Tx
