Bronchiectasis and Fibrotic lung disease Flashcards
What is bronchiectasis
- This is chronic inflammation of the bronchi and bronchioles that leads to a permanent dilatation and thinning of these airways
What are the main organisms that cause bronchiectasis
- H.influenzae
- Strep.pneumoniae
- Staph.aureus
- Pseudomonas aeruginosa
What are the common causes of bronchiectasis
Congenital
- Cystic fibrosis
- young’s syndrome
- primary colliery dyskinesia
- Kartagener’s syndrome
Post infection
- measles
- pertussis
- bronchiolitis
- pneumonia
- TB
- HIV
Other
- bronchial obstruction
- allergic bronchopulmonary aspergillosis
- rheumatoid arthritis
- ulcerative colitis
What are the symptoms of bronchiectasis
- persistent cough
- large amounts of purulent sputum
- intermittent haemoptysis
- breathlessness occurs as disease progression
- infection characterised by increase sputum volume and purulence
- pleuritic chest pain
- coarse crackles can occur
What are the signs of bronchiectasis
- finger clubbing
- coarse inspiratory crepitations
- wheeze
What are the complications of bronchiectasis
- pneumonia
- pleural effusion
- pneumothorax
- haemoptysis
- cerebral abscess
- amyloidosis
What investigations do you use to diagnose bronchiectasis
- HRCT scanning
- Sputum culture
- CXR
- spirometry
- bronchoscopy
- serum immunoglobulins
- CF - Sweat test
- skin prick test
- aspergillus precipitins
What differences do you observe on an CXR to diagnose bronchiectasis with
- cystic shadows
- thickened bronchial walls
What does spirometry show in bronchiectasis
- obstruction pattern
- reversibility should be assessed
What is the global leading cause of bronchiectasis
TB
describe the pathophysiology of bronchiectasis
- abnormal and permanently dilated airways
- characterised by a vicious circle of neutrophilic inflammation, recurrent infection and damage to the airways
- this impairs mucociliary clearance and persistent inflammation which leads to the impairment of immunity
What is the management for bronchiectasis
- airway clearance
- anti-inflammatories
- antibiotics
- bronchodilators
- ## corticosteroids
Describe how you would use airway clearance in bronchiectasis
- airway clearance techniques and mucolytics
- chest physiotherapy and devices such as a flutter valve can help sputum expectoration and mucus drainage
Why are anti-inflammatories sued in bronchiectasis
- long term azithromycin has an immunomodulatory effect and has been demonstrated to reduce exacerbation
When should antibiotics be prescribed in bronchiectasis and what antibiotics should be prescribed
- Should be prescribed according to bacterial sensitivities
- patients known to culture pseudomonas aeruginosa require either oral ciprofloxacin
- if you have more than or equal to 3 exacerbations a year long term antibiotic should be considered
Why is P.aeruginosa important to isolate in bronchiectasis
patients with P. aeruginosa experience an accelerated decline in lung function and more frequent exacerbations
- increases morbidity
What are the differential diagnosis of a cough with sputum
- infection
- COPD
- cystic fibrosis
- pneumonia
- lung abscess
- pulmonary edema
Name the similarities and differences between COPD and Bronchiectasis
COPD
- caused by smoking or environmental causes
- corticosteroid and LABA/LAMA treatment
Bronchiectasis
- consistent infection
- excess mucus
- treatment involves airway clearance and antibiotics to treat infection
Both have similar symptoms
What is the pathophysiology of fibrotic lung disease
- there is fibrosis and remodelling of the interstitium
- chronic inflammation
- hyperplasia of type II epithelial cells
- type II pneumocytes
What are the common causes of fibrotic lung disease
known cause
- occupation
- drugs
- hypersensitivity reactions
- infections
Systemic disorders
- sarcoidosis
- rheumatoid arthritis
- SLE
- ulcerative colitis, renal tubular acidosis, autoimmune thyroid diseases
Idiopathic
- idiopathic pulmonary fibrosis
- cryptogenic organising pneumonia
- non-specific interstitial pneumonitis
What are the symptoms of fibrotic lung disease
- dyspnoea on exertion
- non productive paroxysmal cough
- abnormal breath sounds
What are the signs of fibrotic lung disease
- abnormal CXR
- restrictive pulmonary spirometry
- decrease DLCO
What investigations are used to confirm the diagnosis of fibrotic lung disease
- CXR
- Spirometry
- DLCO
What causes fibrotic shadowing in the upper zone of a CXR
- TB hypersensitivity pneumonitis
- ankylosing spondylitis
- radiotherapy
- progressive massive fibrosis
What causes fibrotic shadowing in the mid zone of a CXR
- sarcoidosis
- histoplasmosis
What causes fibrotic shadowing in the lower zone of a CXR
- idiopathic pulmonary fibrosis
- asbestosis
How do you manage fibrotic disease
- corticosteroids
- oxygen support
- pulmonary rehabilitation
- lung transplant
