Condition- Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

A disorder chaacterised by permanent dilation of the bronchi, impaired mucociliary clearance and frequent bacterial infections

Question 2

What causes the permanent dilation of bronchi in bornchiectasis?

Answer 2

1. Chronic lung inflammation
2. Destruction of the elastic and muscular components of the bronchial wall
3. Fibrosis and permanent dilation of the bronchi
4. This leads to pooling of mucus
5. Further cycles of infection, damage and fibrosis of bronchial walls

Question 3

List some causes of Bronchiectasis

Answer 3

• IDIOPATHIC
• Post-infective: tuberculosis, measles, pertussis, pneumonia, ABPA
• Genetic: CF, ciliary dyskinesia (Kartagener’s syndrome, Young’s syndome), a1 anti-trypsin deficiency
• Bronchial obstruction e.g. lung cancer/foreign body
• Immune deficiency: Ig deficiency, HIV
• IBD
• Conective tissue disorders: Rheumatoid

Question 4

Kartagener’s syndrome is characterised by a triad of…

Which other conditions might it be associated with? (2)

Answer 4

1. Bronchiectasis
2. Sinusitis
3. Situs Inversus (organs on wrong side of body)

• Otitis Media (wax not removed)
• Infertility

Question 5

List some of the presenting symptoms of bronchiectasis…

Answer 5

• Productive Cough- cupfuls foul smelling pus worse on lying flat
• Intermittent Haemoptysis- speckled blood
• SOB
• Pleuritic Chest pain
• Fever
• Lethargy
• Weight Loss

Question 6

List some key findings of Bronchiectasis on clinical examination

Answer 6

• Clubbing
• Wheeze
• Coarse-inspiratory crackles at lung bases

Question 7

What can be seen on a CXR of a patient with Bronchiectasis?

Answer 7

May be normal - may see Tram lines

Question 8

Which investigation is required to diagnose Bronchiectasis and what would be a positive result?

Answer 8

Signet rings signs (dilated bronchioles)

Tram Lines

Question 9

Other than imaging what other test could you conduct on a pt with bronchiectasis

Answer 9

• Sputum sample + MC&S to check for infective cause
• Spirometry- gives obstructive picture

Question 10

How could bronchiectasis be conservatively managed?

Answer 10

• Physical trainging (e.g. inspiratory muscle training)
• Postural drainage- for sputum and mucus clearance
• High frequency oscillation devices
• Nebulised hypertonic saline
• Immunisations

Question 11

How could you medically and surgically manage bronchiectasis patients?

Answer 11

MEDICAL

• Antibiotics for acute infective exacerbations but can also be used as prophylaxis in some
• Bronchodilators for those who show reversibility
• Corticosteroid to reduce inflammation

SURGICAL

• lung resection if localised disease

Question 12

List some of the potential complications of Bronchiectasis…

Answer 12

• Life-threatening haemoptysis
• Pneumonia
• Pneumothorax
• Empyema
• Respiratory failure
• Cor pulmonale
• Amyloidosis