Lower respiratory tract diseases - BRONCHIECTASIS Flashcards
what is bronchiectasis?
= abnormal and PERMANENTLY DILATED airways
who most commonly gets bronchiectasis?
median age is 50 years
- however, patients often had symptoms for over 10-20 years
- most cases (60%) occur inn women
what 3 things are characteristic of bronchiectasis?
1) neutrophilic inflammation
2) recurrent infection
3) damage to the airway
what effect do these 3 things have on mucous clearance and immunity?
- impairs mucociliary clearance
- impaired immunity caused by persistent inflammation
what causes bronchiectasis?
1) congenital causes
- deficiency of bronchial wall
2) bronchial obstruction
- foreign body
- mucus
- post TB stenosis
- tumour
- lymph node
3) post-infection bronchial damage
4 ) granuloma
- Tuberculosis, sarcoidosis
5) mucociliary clearance defects
- cystic fibrosis
- primary ciliary dyskinesia
- young’s syndrome
6) immune deficiency
- HIV & malignancy
- SELECTIVE IMMUNOGLOBULIN DEFICIENCIES (IgA & IgG)
7) immunological over-response
- allergic broncho-pulmonary aspergillosis
- post-lung transplant
8) diffuse diseases of lung parenchyma
- idiopathic pulmonary fibrosis
symptoms of bronchiectasis?
- COUGH
- chronic daily SPUTUM PRODUCTION (large amounts of it)
- breathlessness if the disease progresses
- minor haemoptysis (usually a sign of infection)
- pleuritic chest pain & severe & systemic upset can be signs of infection
on examination what could be expected?
- coarse crackles on auscultation but examination can be normal
- clubbing can occur, especially in cystic fibrosis
how would you investigate bronchiectasis?
1) chest X-ray
2) high resolution CT scan
3) sputum examination
4) immune assessment
5) sweat tests & cystic fibrosis genetic assessment
6) nasal nitric oxide
7) total IgE & aspergillus specific IgE or aspergillus skin prick testing
what would a chest X-ray show in a patient with bronchiectasis?
- most often will be normal
- but may show bronchial wall thickening
- ring shadows
- tramlines
what would a high resolution CT scan show?
- tram-track airways
- increased bronchoarterial ratio
what would the immune assessment look at?
- immunoglobulins and responses to;
- haemophilus influenza b
- tetanus
- pneumococcal vaccines as a baseline test
what type of patient should sweat tests & cystic fibrosis genetic assessment be carried out?
- patients under the age of 40
what is nasal nitric oxide a useful test for?
- for screening for primary ciliary dyskinesia (PCD)
why should total IgE & aspergillus specific IgE or aspergillus skin prick testing be done?
to exclude allergic broncho-pulmonary aspergillosis
name 3 ways to manage bronchiectasis?
1) airway clearance
2) anti-inflammatories
3) treatment of infection
give examples of airway clearance mechanisms?
- activated cycle of breathing technique
- autogenic (self)-drainage
- postural drainage
- nebulised hypertonic saline works as a muco-active agent
name a drug used for anti-inflammatory
azithromycin, is a long term immunomodulator
what does azithromycin do?
- reduces exacerbation frequency
- reduces inflammation
when treating infections caused by the bacteria pseudomonas aeruginosa what type of therapy should be used and why?
- DUAL therapy should be used
- due to multi-resistant pathogens
what drug/(s) should be used to treat pseudomonas haemophilus influenzae?
- high dose ciprofloxacin (oral drug)
- amoxicillin
- co-amoxiclav
- doxycycline
all oral antibiotics
what do multi-resistant species need to be treated?
intravenous cephalosporin treatment
