Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Chronic inflammation of the bronchioles and bronchi leading to permanent dilation and thinning of the airways.

Question 2

What are the main organisms causing bronchiectasis?

Answer 2

1. Haemophilus influenzae
2. Strep pneumoniae
3. Staph aureus
4. Pseudomonas aeruginosa

Question 3

What are the causes of bronchiectasis?

Answer 3

Congenital - CF, Youngs syndrome, primary ciliary dyskinesia, Kartaneger’s syndrome
Post infective - Measles, pneumonia, TB, HIV
Obstructive - Foreign body, tumour, extrinsic lymph node
Other - Allergic bronchopulmonary aspergillosis, RA, UC, idiopathic

Question 4

What is Young’s syndrome?

Answer 4

Triad of bronchiectasis, male infertility and sinusitis

Question 5

What is Kartagener syndrome?

Answer 5

A type of primary ciliary dyskinesia, also leading to situs invertus totalis. Leads to frequent respiratory infections when the patient is young.

Question 6

What are some symptoms of bronchiectasis?

Answer 6

Chronic cough, copious purulent sputum, intermittent haemoptysis, breathlessness on exertion, chest pain, fatigue

Question 7

What are some signs of bronchiectasis?

Answer 7

Finger clubbing, coarse inspiratory crepitations, wheeze

Question 8

What are some complications of bronchiectasis?

Answer 8

Pneumonia, pleural effusion, pneumothorax, haemoptysis, cerebral abscess, amyloidosis

Question 9

What is the pathophysiology of bronchiectasis?

Answer 9

1. All causative organisms impair airway clearance or host defences, resulting in an inability to clear mucus.
2. This predisposes to chronic infection and inflammation.
3. Airways become blocked with mucus containing inflammatory mediators and pathogens.
4. This causes destruction of elastic and muscular components of the bronchial wall and causes peribronchial fibrosis.
5. This leads to dilation, so mucus clearance impaired more, so more infection and more dilation = viscious cycle.

Question 10

How is bronchiectasis diagnosed?

Answer 10

1. Bedside -
   - Sputum culture
   - Spirometry - Obstructive pattern
2. Imaging -
   - CXR - Cystic shadows, thickened bronchial walls, tram track sign
   - HRCT chest - Gold standard. Signet ring sign where bronchus is dilated wider than the accompanying pulmonary artery.
3. Procedures -
   - Bronchoscopy - Locate site of haemoptysis, exclude obstruction, obtain samples for culture
4. Other -
   - Serum immunoglobulins, CF sweat test, aspergillus testing

Question 11

What is the management for bronchiectasis?

Answer 11

1. Airway clearance/mucolytics - Chest physiotherapy or a flutter valve
2. Antibiotics - According to regular sputum culture. Consider long term prophylaxis if 3+ exacerbations in a year
3. Bronchodilators - Useful in patients with asthma, COPD, CD, ABPA
4. Corticosteroids - If ABPA
5. Surgery - To control localised disease/severe haemoptysis
6. Flu vaccination/pneumococcal vaccination