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Respiratory Medicine > Bronchiecteisis > Flashcards

Bronchiecteisis Flashcards

1
Q

What is the definition of bronchiectasis?

A
  • Abnormal and permanent dilatation of airways
  • Bronchial walls become inflamed, thickened and irreversibly damaged
  • The mucociliary elevator is impaired
  • Mucus accumulates leading to increased susceptibility to infection
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2
Q

What is the epidemiology of bronchiectasis?

A

Prevalence in the UK estimated as 100/100,000

Prevalence increases with age

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3
Q

What are the complications of bronchiectasis?

A

Congenital

  • Cystic Fibrosis
  • Primary Ciliary dyskinesia (sinusitis, bronchiectasis and azospermia)
  • Kartagener’s (primary ciliary dyskinesia with dextrocardia and situs inversus)
  • Young’s syndrome (azospermia and sinusitis)
  • Pulmonary sequestration

Mechanical obstruction

  • Foreign body
  • Bronchial carcinoma
  • Post-TB Stenosis
  • Lymph node

Post-Infective

  • Measles
  • TB
  • Pertussis
  • Bacterial and viral pneumonia

Granulomatous Disease

  • TB
  • Sarcoidosis

Usual interstitial pneumonia (cryptogenic fibrosing alvelolitis)

Immune over-activity

  • Allergic broncho-pulmonary aspergillosis (ABPA)
  • Inflammatory bowel disease
  • Rheumatoid arthritis
  • Sjorgrens
  • Post lung transplant

Immune deficiency

  • Hypogammaglobulinaemia
  • Selective immunoglobulin deficiencies (IgA and IgG2)
  • Secondary: HIV, malignancy

Aspiration

  • Chronic alcoholics
  • GORD
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4
Q

What are the symptoms of bronchiectasis?

A 
Cough
Shortness of breath
Excessive sputum production
Recurrent chest infections
Haemoptysis
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5
Q

What are the signs of bronchiectasis?

A

Cachexia and lymph nodes
Clubbing
Hyperinflation

On Auscultation:

  1. Coarse crackles in affected areas: mixed character, alter with coughing
  2. Squeaks and Wheeze
  3. Inspiratory clicks
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6
Q

What are the differential diagnosis of bronchiectasis?

A

Pulmonary fibrosis
Bronchial carcinoma
Chronic lung abscess
Asbestosis

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7
Q

What are the investigations for bronchiectasis?

A
  1. Sputum culture and cytology
  2. CXR
    - Tramlines and ring shadows. Bullae.
  3. HRCT
    - “Signet ring” sign: thickened, dilated bronchi larger than the adjacent vascular bundle
  4. Sinus x-rays
    - 30% have concomitant sinusistis
  5. Spirometry
    - Normal/ restrictive picture
For a specific cause:
Bronchoscopy
Immunoglobulins
Aspergillus RAST and skin prick testing
Sweat electrolyte test
Mucocilliary clearance - Nasal saccharine taste test: 1mm cube of saccharine placed on inferior turbinate should be tasted within 30mins
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8
Q

What is the non-pharmacological management of bronchiectasis?

A
  1. Multidisciplinary team (MDT) input
  2. Physiotherapy
    - Postural drainage
    - Active cycle breathing
  3. Smoking cessation
  4. Immunisations
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9
Q

What is the medical management of bronchiectasis?

A
  1. Antibiotics
    - To treat exacerbations refer to local guidelines but examples include:
    - Amoxicillin 500mg tds or clarithromycin 500mg bd for 2 weeks as 1st line
    - Ciprofloxacin in pseudomonas colonisation
    - High dose maybe needed in severe bronchiectasis with Haemophilus infuenzae B colonisation e.g. amoxicillin 1g tds
  2. Long term antibiotics
    - Consider in patients having ≥ 3 exacerbations per year or patients with fewer exacerbations causing significant morbidity e.g. low dose azithromycin three times per week
    - Inhaled antibiotics can also be used
  3. Bronchodilators/ inhaled corticosteroids if there is any evidence of airflow obstruction
  4. Inhaled Saline
  5. NIV/ Intermittent positive pressure may be used to augment tidal volume and reduce work of breathing
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10
Q

What is the surgical management of bronchiectasis?

A

Resection in localised disease

  • Lung transplant (heart/lung transplant)
  • Bronchial artery emobolisation or surgery for management of haemoptysis
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11
Q

What are the complications of bronchiectasis?

A 
Progressive respiratory failure
Cor pulmonale
Pneumonia
Pneumothorax
Empyema
Life-threatening haemoptysis: Mycotic aneurysm (esp. in patients with CF)
Secondary amyloidosis
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12
Q

What is the prognosis of bronchiectasis?

A

Vastly improved with antibiotic therapy, but most still eventually progress to respiratory failure due to chronic damage.

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13
Q

What organisms are commonly associated with bronchiectasis?

A

Staph aureus
Haemophilus influenza
Pseudomonas

Rarer:
Pneumococcus
Klebsiella

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14
Q

What is yellow nail syndrome?

A

Bronchiectasis + yellow nails + lymphoedema

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Respiratory Medicine (20 decks)

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