Case 1 - Christine - Bronchiectasis Flashcards
What is bronchiectasis?
Airways of the lungs permanently widen and thicken, causing build up of mucus and increased risk of infection
What are you likely to hear on auscultation?
During both phases of respiration; loud course crackles
ACBT step-by-step
- 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.
2 different types of huff
Mid to low volume = distal areas of lungs.
High to mid volume = proximal areas of lungs.
What does BC do?
Prevent bronchospasm, SOB, hyperventilation, minimize fatigue, promote relaxation.
What does TE do?
Increases lung volume, promotes airflow through collateral ventilation system (bypassing normal airways to modulate ventilation perfusion imbalance due to disease)
What are some collateral channels of ventilation?
Interbronchiolar channels of martin, bronchiolar-alveolar channels of lambert, alveolar pores of kohn.
Huff physiology
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.
ACBT precautions
Acute, unstable head, neck, or spine injury. Watch out for dizziness, SOB, and bronchospasm.
Flutter step-by-step
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.
What is the flutter doing?
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.
Simple spirometry
FEV1 (obstruction) = volume of gas exhaled during first second of rapid, forceful expiration.
FVC (volume) = volume of gas exhaled during rapid, forceful expiration.
FER (forced expiratory ratio)
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.
What would bronchiectasis look like on CXR?
Often abnormal but non-specific, can show ‘tram-track’ sign. Parallel line opacities along the length of dilated and thickened bronchi.