Bronchiectasis Flashcards
What is bronchiectasis? (x3 characteristics)
Lung airway disease of the BRONCHI characterised by chronic bronchial dilation, impaired mucociliary clearance and frequent bacterial infections.
What is the pathophysiology of bronchiectasis?
Severe inflammation causes fibrosis and dilation of bronchi (from destruction of elastic and muscular components of bronchial walls), followed by pooling of mucus predisposing to further cycles of infection, damage and fibrosis to bronchial walls.
What is the aetiology of bronchiectasis? (x6 (x4))
- Idiopathic in 50% of cases
- Post-infectious: after pneumonia, Whooping cough, TB
- Host defence defects: Kartagener’s syndrome (immotile cilia and characterised by chronic sinusitis, infertility and situs inversus (thorax organs mirror image of normal positions)), CF, immunoglobulin deficiency (such as HIV), yellow-nail syndrome (characterised by pleural effusions, lymphoedema and yellow dystrophic (degenerating) nails)
- Obstruction of bronchi from foreign body or lymphadenopathy
- GORD
- Inflammatory disorders such as rheumatoid arthritis leading to connective tissue changes
- Bronchogenic carcinoma
What is the epidemiology of bronchiectasis: Age? Trend? Incidence?
Highest incidence in childhood, decreasing incidence because of antibiotics, and approximately 1 in 1000 per year.
What are the symptoms of bronchiectasis? (x5)
• CHRONIC DISEASE - NOT ACUTE.
Productive cough with purulent sputum or haemoptysis (usually specks) – acute exacerbations of bronchiectasis are characterised by changes in sputum colour and increase in volume
- Breathlessness
- Pleuritic chest pain in exacerbations
- Rhinosinusitis when bronchiectasis is due to mucociliary defect
- Constitutional symptoms: malaise, fever, weight loss
What are the signs of bronchiectasis? (x3)
• Finger clubbing • High-pitched, coarse inspiratory crepitations, usually at lung bases • Rhonchi (low-pitched wheeze; expiration)
How does bronchiectasis present on CXR? (x4)
- Dilated bronchi may be seen as parallel lines (tramline shadows) radiating from hilum to the diaphragm
- Air fluid levels may be seen in cystic bronchiectasis
- Bronchi seen end-on may appear as ring shadows/opacities
- May also show fibrosis
What is the importance of CXR for investigating bronchiectasis, beyond diagnosis?
Screen for lung cancer too.
What may you see in sputum in bronchiectasis? (x7)
Culture and sensitivity – common organisms in acute exacerbations include Pseudomonas aeruginosa, Haemophilus influenza, Staph. aureus, Strep. pneumoniae, Klebsiella, Moraxella catarrhalis, Mycobacteria.
What other investigations are there for bronchiectasis? (x4)
- FBC: elevated WCC in exacerbation
- CT: dilated bronchi with thickened walls – best diagnostic method
- Bronchography (CXR following coating respiratory tree in contrast; rarely done): determine disease extent before surgery
- Sweat electrolytes (high chloride in test is indicative of CF)
How is bronchiectasis managed (non-surgical)? (x6)
- Treat exacerbations: with IV antibiotics with efficacy for Pseudomonas
- Prophylactic antibiotics for those with frequent (more than 3 a year) exacerbations
- Physiotherapy: sputum and mucus clearance techniques such as, vibration, percussion and postural drainage (patients taught to position themselves so the lobe to be drained is uppermost for 20 minutes a day). This reduces frequency of exacerbations and aids recovery.
- Smoking cessation
- Inhaled corticosteroids (such as fluticasone) to reduce inflammation and volume of sputum
- Bronchodilators
How may bronchiectasis be surgically managed? (x3)
- Bronchial artery embolization: for life-threatening haemoptysis
- Localised resection of affected lung
- Lung transplant (heart-lung transplant if cor pulmonale)
What are the complications of bronchiectasis? (x6)
Life-threatening haemoptysis, persistent infections, emphysema, respiratory failure, cor pulmonale (fibrosis results in pulmonary hypertension), multi-organ abscesses.
What is the prognosis of bronchiectasis?
Irreversible
What is atelectasis?
Collapse of lung due to reduced or absent gas exchange. It is a condition where the alveoli are deflated down to little or no volume; different from pulmonary consolidation, in which they are filled with liquid.
