Bronchiectasis (RESP) Flashcards
Define bronchiectasis.
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
What is bronchiectasis a consequence of?
Recurrent and/or severe infections secondary to an underlying disorder
How can you classify bronchiectasis? (2)
- CF bronchiectasis
- non-CF bronchiectasis
What are some causes of bronchiectasis? (11)
- 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)
What are the clinical features of cystic fibrosis (bronchiectasis)? (5)
- recurrent chest infections
- failure to thrive (delayed puberty)
- malabsorption (steatorrhoea)
- short stature
- male infertility
How is cystic fibrosis (bronchiectasis) diagnosed?
Via sweat test (abnormally high sweat chloride)
How is cystic fibrosis (bronchiectasis) screened?
At birth via heel prick
How do you manage cystic fibrosis (bronchiectasis)?
Chest physiotherapy
What are the clinical features of allergic bronchopulmonary aspergillosis (bronchiectasis)? (3)
- wheeze
- dry cough
- dyspnoea
What would you find on bloods in allergic bronchopulmonary aspergillosis (bronchiectasis)? (2)
- eosinophilia
- raised IgE
How do you manage allergic bronchopulmonary aspergillosis (bronchiectasis)?
Oral prednisolone
How does obstructive disease cause bronchiectasis?
Mucus plugs form in airways and obstruct airways
What are the most common organisms that cause bronchiectasis? (4)
- Haemophilus influenzae (most common)
- Pseudomonas aeruginosa
- Klebsiella spp.
- Streptococcus pneumoniae
What are the clinical features of bronchiectasis? (10)
- 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
What might you see on examination in bronchiectasis? (3)
- clubbing
- coarse inspiratory crackles - usually at lung base, shift with coughing, rhonchi, high-pitched inspiratory squeaks
- wheeze (high-pitched inspiratory squeaks)
What are the risk factors for bronchiectasis? (6)
- 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
What are the 1st-line investigations for bronchiectasis? (6 + 6)
- 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)
What initial investigation do you request for bronchiectasis and what would this show? (7)
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
What is the gold-standard confirmatory test for bronchiectasis and what would it show? (5)
High resolution chest CT
- thickened, dilated airways
- varicose constrictions along airways
- cysts and/or tree-in-bud pattern
- signet ring sign
- tram-track sign
What does spirometry show in bronchiectasis?
Obstructive pattern (<0.7) - assess reversibility
Why do we do sputum MC&S for bronchiectasis?
To look for underlying cause - may find H. influenzae (most common) or Pseudomonas aeruginosa (most common in CF patients)
What would we see in CF on the cystic fibrosis sweat test?
Abnormally high chloride
What are some differential diagnoses for bronchiectasis? (4)
- 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
What is included in the management plan for bronchiectasis? (7)
- 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)
When is surgery done for bronchiectasis?
Lobectomy in uncontrolled haemoptysis or localised disease
Why do we do inspiratory muscle training in bronchiectasis?
Good evidence base for patients with non-CF bronchiectasis
What long term prophylactic Abx can be used in Pseudomonas aeruginosa bronchiectasis infections?
Oral macrolides or inhaled aminoglycosides
What are some complications of bronchiectasis? (4)
- massive haemoptysis
- respiratory failure
- cor pulmonale
- ischaemic stroke
Describe the prognosis of bronchiectasis.
Irreversible condition, the typical disease course consists of periods of symptom control interrupted by periods of exacerbations
