GP/ medicine - Bronchiectasis Flashcards
What is bronchiectasis?
Permanent diltation of one or more bronchi and thickening of the airways secondary to chronic infection or inflammation of the airways
(Since any disease that causes chronic infection or chronic inflammation to the airways can cause bronchiectasis, there are a large number of diseases that can cause bronchiectasis)
Is Bronchiectasis a disease that affects a particular age group of people?
NOOOOOOO - it affects both children and adults equally
Give 5 causes of bronchiectasis
- Previous severe LRTI e.g. pneumonia, TB, influenza (most common)
- Immunodeficiency - HIV, hypogammaglobulinaemia, malignancy
- Genetics / Mucociliary clearance defects - CF, primary ciliary dyskinesia (Young’s syndrome, Kartagener’s syndrome)
- Bronchial obstruction - FB, lung cancer, enlarged lymph node
- Allergic bronchopulmonary aspergillosis (a cause of eosinophilia)
- Gastric aspiration (particularly after lung transplant)
- Ulcerative colitis, Yellow nail syndrome
What is the pathophysiology of bronchiectasis?
Causes of bronchiectasis –> the bronchi exhibit poor mucus clearance –> accumulation of mucus in lungs –> bacterial colonisation –> recurrent / chronic chest infections –> chronic productive cough with excessive sputum production
The airways are inflamed and easily collapse, causing dyspnoea
Recurrent chest infections eventually cause remodelling of the airway and bronchi, causing permanent dilatation of one or more bronchi and thickening of the airways, which makes the airway even more prone to mucus collection and infections
Is smoking a risk factor for bronchiectasis?
NOOOOOOOOOOOO!!!!
What are Young syndrome and Kartagener syndrome?
Young syndrome - bronchiectasis, sinusitis, infertility
Kartagener syndrome - bronchiectasis, sinusitis, situs inversus
What things are associated with a poor prognosis in bronchiectasis?
Extensive disease
Frequent exacerbations
The patient smokes
Infection with pseudomonas
Primary antibody deficiency disorder
Give 3 complications of bronchiectasis
Infective exacerbations of bronchiectasis
Respiratory failure
Severe haemoptysis (as much as 2/3rd of a mug full)
Pneumothorax
Cor pulmonale
What are the symptoms of bronchiectasis?
Symptoms:
- Persistent productive cough with large volumes of purulent sputum
- Dyspnoea
- Haemoptysis
- Chest pain (non-pleuritic)
- Hx of recurrent chest infections
- Absence of smoking Hx
What are the signs of bronchiectasis?
Signs:
- Coarse crackles, often in lower lung zones
- Wheeze
- Large airway rhonchi (low pitched snore-like sounds)
- Finger clubbing
What symptoms suggest infective exacerbation of bronchiectasis?
Worsening cough
Worsening dyspnoea
Increased sputum volume and purulence
Fever
What organisms are commonly found in someone with bronchiectasis?
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
Staphylococcus auerus (less common but associated with CF)
Which organism is MOST COMMONLY found in bronchiectasis?
Haemophilus influenza
If Staphylococcus aureus is found in sputum culture in a young person with bronchiectasis, what cause are you thinking?
Cystic Fibrosis (CF)
(Another condition is Allergic bronchopulmonary aspergillosis, however, it’s usually in an older age group 20-40 yrs)
How do you manage bronchiectasis?
