PBL: Bronchiectasis

Question 1

RF for bronchiectasis

Answer 1

• Chronic smoking: chronic bronchitis (mucous production), COPD
• TB
• Autoimmune: RA, CVID
• Congenital: cystic fibrosis (CFTR gene mutation)

Question 1

Typical presentation of bronchiectasis?

Answer 1

• Chronic mucopurulent cough with haemoptysis presentation, finger clubbing (chronic suppurative disease/hypoxemia), thin (catabolic state)

Mx of haemptysis
* IV fluids, IV antibiotics (infective exacerbation of broncheictasis) transaminic acid, bronchial artery embolization

May have bronchoarterial hypertrophy = destruction of bronchopulmonary bundle

Question 2

Non resp conditions in bronchiectasis?

Answer 2

• GERD: irritant especially at night due to impaired consiousness causing silent aspiration
• Nose: chronic sinusitis (ciliary problem in kartagener –> chronic rhinosinusitis –> runny nose presentation –> post nasal drip (irritant and cause cough –> can cause aspiration)

Question 3

Common bacteria in bronchiectasis?

Answer 3

• Pseudomonas aeruginosa, klebsiella pneumonia (associated with DM), e.coli (aspiration pneumonia)

Others non specific infection: H.influenzae, M. catarrhalis, strept pneumoniae.

Question 4

What mycobacterial disease association with bronchiectasis?

Answer 4

• MTB
• Non tuberculous mycobacterium: M.marinuum, M.abscessus, M.leprae, M. fortuitum (haemoptysis), M. kanasii
• If AFP culture and smear +ve. Ask history of NTM( Bound to collect sample of NTM which grow faster thena MTB) and look at specimen date

Question 5

What is lung function test for bronchiectasis?

Answer 5

• Normal
• Obstructive pattern: disease itself causing airflow obstruction (results in mucous retention)
• Mixed pattern

Question 6

What immunomodulatory option is there for bronchiectasis?

Answer 6

Macrolides
* Half the dosage of treatment dosage taken 3 times a week done for around a year for efficacy. Can be done indefinitely if there is decreased exacerbation (can go on drug holiday: no strict guideline for timespan)
* Comparison to macrolides for treatment which is everyday for 1 week

Question 7

What is used for mx if more than 3x exacerbation of bronchiectasis?

Answer 7

Inhaled gentamicin/tobromycin (aminoglycosides) for pseudomonas aeruginosa infection
* Toxicity of aminoglycosides: nephrotoxicty, ototoxicity, vestibular toxicity
* Inhaled antibiotics used for cystic fibrosis
* With chronic colonization of pseudomonas –> aim for bacteriostatic status
* Nebulized twice daily for 2-4 week cycles –> than off for stabilization of 2-4 weeks

Preemptive IV antibiotics to reduce exacerbation: routinely come back every couple of months

Question 8

Non pharmacological mx of repeated exacerbation of bronchiectasis?

Answer 8

Sputum clearance
* Better cough techniques
* Physical resonance
* Chest percussion (cupped hand): degree of resonance on the chest wall

Postural drainage