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Year 3 > Bronchiectasis (RESP) > Flashcards

Bronchiectasis (RESP) Flashcards

1
Q

Define bronchiectasis.

A

Permanent abnormal dilation of bronchi secondary to chronic infection or inflammation, due to the destruction of the elastic and muscular components of the bronchial wall + impaired mucociliary clearance

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2
Q

What is bronchiectasis a consequence of?

A

Recurrent and/or severe infections secondary to an underlying disorder

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3
Q

How can you classify bronchiectasis? (2)

A
  • CF bronchiectasis
  • non-CF bronchiectasis
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4
Q

What are some causes of bronchiectasis? (11)

A
  • idiopathic (50%)
  • post-infective/recurrent pulmonary infections (measles, pertussis, pneumonia)
  • cystic fibrosis - autosomal recessive disorder causing increased viscosity of secretions due to defect in CFTR
  • TB
  • COPD
  • aspiration
  • chronic inflammatory diseases e.g. RA, coeliac disease
  • allergic bronchopulmonary aspergillosis (ABPA) - bronchiectasis + bronchoconstriction caused by hypersensitivity response to aspergillus fungus
  • primary ciliary dyskinesia (Kartagener’s syndrome) - bronchiectasis + dextrocardia (or complete sinus inversus) + recurrent sinusitis (+ male infertility)
  • bronchial obstruction (lung cancer, foreign body)
  • immune deficiency (selective IgA, hypogammaglobulinaemia)
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5
Q

What are the clinical features of cystic fibrosis (bronchiectasis)? (5)

A
  • recurrent chest infections
  • failure to thrive (delayed puberty)
  • malabsorption (steatorrhoea)
  • short stature
  • male infertility
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6
Q

How is cystic fibrosis (bronchiectasis) diagnosed?

A

Via sweat test (abnormally high sweat chloride)

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7
Q

How is cystic fibrosis (bronchiectasis) screened?

A

At birth via heel prick

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8
Q

How do you manage cystic fibrosis (bronchiectasis)?

A

Chest physiotherapy

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9
Q

What are the clinical features of allergic bronchopulmonary aspergillosis (bronchiectasis)? (3)

A
  • wheeze
  • dry cough
  • dyspnoea
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10
Q

What would you find on bloods in allergic bronchopulmonary aspergillosis (bronchiectasis)? (2)

A
  • eosinophilia
  • raised IgE
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11
Q

How do you manage allergic bronchopulmonary aspergillosis (bronchiectasis)?

A

Oral prednisolone

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12
Q

How does obstructive disease cause bronchiectasis?

A

Mucus plugs form in airways and obstruct airways

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13
Q

What are the most common organisms that cause bronchiectasis? (4)

A
  • Haemophilus influenzae (most common)
  • Pseudomonas aeruginosa
  • Klebsiella spp.
  • Streptococcus pneumoniae
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14
Q

What are the clinical features of bronchiectasis? (10)

A
  • chronic cough associated with large/copious amounts of purulent sputum (green/rusty colour) - may be worsened lying flat/on one side
  • haemoptysis (red-tinged sputum)
  • recurrent chest infections
  • SOB (especially on exertion)
  • chest pain
  • malaise
  • fever
  • weight loss
  • symptoms usually begin after acute respiratory illness + worsen during acute exacerbations
  • acute exacerbation: fatigue, weight loss, wheezing
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15
Q

What might you see on examination in bronchiectasis? (3)

A
  • clubbing
  • coarse inspiratory crackles - usually at lung base, shift with coughing, rhonchi, high-pitched inspiratory squeaks
  • wheeze (high-pitched inspiratory squeaks)
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16
Q

What are the risk factors for bronchiectasis? (6)

A
  • cystic fibrosis
  • host immunodeficiency
  • previous infections
  • congenital disorders of the bronchial airways
  • primary ciliary dyskinesia
  • tall, thin, white females 60+ –> pulmonary non-TB mycobacteria-related bronchiectasis
17
Q

What are the 1st-line investigations for bronchiectasis? (6 + 6)

A
  • high-resolution chest CT
  • CXR
  • FBC
  • sputum culture + sensitivity
  • sweat chloride test
  • pulmonary function tests
  • (serum alpha-1 antitrypsin phenotype and level)
  • (serum immunoglobulins)
  • (rheumatoid factor)
  • (specific IgE or skin-prick test to Aspergillus fumigatus)
  • (serum HIV antibody)
  • (nasal NO)
18
Q

What initial investigation do you request for bronchiectasis and what would this show? (7)

A

CXR

  • obscured hemidiaphragm
  • thin-walled ring shadows with/without fluid levels
  • tubular or ovoid opacities
  • dilated bronchi –> tram lines (parallel line shadows from hilum to diaphragm)
  • fibrosis
  • atelectasis
  • pneumonic consolidation
19
Q

What is the gold-standard confirmatory test for bronchiectasis and what would it show? (5)

A

High resolution chest CT

  • thickened, dilated airways
  • varicose constrictions along airways
  • cysts and/or tree-in-bud pattern
  • signet ring sign
  • tram-track sign
20
Q

What does spirometry show in bronchiectasis?

A

Obstructive pattern (<0.7) - assess reversibility

21
Q

Why do we do sputum MC&S for bronchiectasis?

A

To look for underlying cause - may find H. influenzae (most common) or Pseudomonas aeruginosa (most common in CF patients)

22
Q

What would we see in CF on the cystic fibrosis sweat test?

A

Abnormally high chloride

23
Q

What are some differential diagnoses for bronchiectasis? (4)

A
  • COPD - diminished breath sounds, no inspiratory squeaks, chest CT normal/emphysema
  • asthma - no inspiratory squeaks
  • pneumonia - more acute
  • chronic sinusitis - no inspiratory squeaks, CXR and CT normal
24
Q

What is included in the management plan for bronchiectasis? (7)

A
  • exercise and improved nutrition
  • airway clearance therapy (chest physiotherapy):
    • postural drainage
    • percussion
    • vibration
    • maintenance of oral hydration
  • inhaled bronchodilator (salbutamol)
  • mucoactive agent e.g. nebulised hypertonic saline
  • antibiotics for exacerbations (e.g. amoxicillin, vancomycin) + long-term rotating antibiotics in severe cases (refractory to medical treatment)
  • immunisations
  • surgery (lobectomy)
25
Q

When is surgery done for bronchiectasis?

A

Lobectomy in uncontrolled haemoptysis or localised disease

26
Q

Why do we do inspiratory muscle training in bronchiectasis?

A

Good evidence base for patients with non-CF bronchiectasis

27
Q

What long term prophylactic Abx can be used in Pseudomonas aeruginosa bronchiectasis infections?

A

Oral macrolides or inhaled aminoglycosides

28
Q

What are some complications of bronchiectasis? (4)

A
  • massive haemoptysis
  • respiratory failure
  • cor pulmonale
  • ischaemic stroke
29
Q

Describe the prognosis of bronchiectasis.

A

Irreversible condition, the typical disease course consists of periods of symptom control interrupted by periods of exacerbations

Year 3 (148 decks)

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