Case 1 - Christine - Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Airways of the lungs permanently widen and thicken, causing build up of mucus and increased risk of infection

Question 2

What are you likely to hear on auscultation?

Answer 2

During both phases of respiration; loud course crackles

Question 3

ACBT step-by-step

Answer 3

• Breathing control (as long as needed).
• Thoracic expansion (max 5, +/- sniff).
• Breathing control
• TE (?)
• BC
• Huff
• Repeat minimum of 10 minutes then ensure 2 clear cycles.

Question 4

2 different types of huff

Answer 4

Mid to low volume = distal areas of lungs.

High to mid volume = proximal areas of lungs.

Question 5

What does BC do?

Answer 5

Prevent bronchospasm, SOB, hyperventilation, minimize fatigue, promote relaxation.

Question 6

What does TE do?

Answer 6

Increases lung volume, promotes airflow through collateral ventilation system (bypassing normal airways to modulate ventilation perfusion imbalance due to disease)

Question 7

What are some collateral channels of ventilation?

Answer 7

Interbronchiolar channels of martin, bronchiolar-alveolar channels of lambert, alveolar pores of kohn.

Question 8

Huff physiology

Answer 8

Equal pressure point (EPP) is created via dynamic collapse and compression of the airway that works to move mucus up along the airway as expiratory airflow propels it through the narrowed portion at the EPP (like squeezing a tube of toothpaste). Additionally, shearing forces help mobilise the secretions.

Question 9

ACBT precautions

Answer 9

Acute, unstable head, neck, or spine injury. Watch out for dizziness, SOB, and bronchospasm.

Question 10

Flutter step-by-step

Answer 10

BC to start then:
- All breaths 2-3 sec breath hold.
- 8-10 mucus loosening breaths (less forceful) (suppress cough).
- 1-2 mucus removal breaths (very forceful) (allow cough).
- Cough/huff at end of reps to expectorate.
- Repeat 10-15minutes.
- Wash device with warm, soapy water.

Question 11

What is the flutter doing?

Answer 11

Generates positive pressure and vibration during exhalation to help mobilise and clear mucus. Back pressure increases and splints open airways to prevent premature closing, reducing gas trapping. Allows gas behind secretions to utilise collateral channels.

Question 12

Simple spirometry

Answer 12

FEV1 (obstruction) = volume of gas exhaled during first second of rapid, forceful expiration.

FVC (volume) = volume of gas exhaled during rapid, forceful expiration.

Question 13

FER (forced expiratory ratio)

Answer 13

FEV1/FVC <0.7 = airflow obstruction. FEV1 is reduced more than FVC.

If it is restrictive, both are reduced and FER is normal (0.75-85) or increased.

Question 14

What would bronchiectasis look like on CXR?

Answer 14

Often abnormal but non-specific, can show ‘tram-track’ sign. Parallel line opacities along the length of dilated and thickened bronchi.