Respiratory Flashcards
What is bronchieactasis?
What are the RF? (2)
What is the main organism?
- Persistent dilation of bronchi secondary to damage from infection and inflammation.
- 60% of diagnoses are in patients over the age of 70
- RF >70, female, smoking history.
-Main organisms –> H influenza (most common), strep pneumoniae, S aureus
What are the different possible causes of bronchieactasis?
- Post infective (most common cause)–> recurrent childhood LRTI infections (flu, pertussis, measles). Pulmonary TB. Allergic bronchopulmonary aspergillosis.
- 40% idiopathic
- Pulmonary disease –> asthma, COPD
- Immunodeficiency e.g HIV, selective IgA
- Congenital –> CF, a-1 antitrypsin deficiency, primary ciliar dyskinesia
- Obstruction –> foreign body, tumour
- Connective tissue/autoimmune – > RA, SLE, sarcoidosis.
What is the typical presentation of bronchieactasis?
- Daily persistent cough w copious amounts of mucopurulent yellow/green sputum – haemoptysis in 50%.
- Exertional SOB, can progress to resting SOB
- Fatigue
- Rhinosinusitis symptoms nasal discharge, nasal obstruction and facial pressure due to underlying mucociliary impairment
- Haemoptysis –> in dry bronchiectasis e.g TB occurs in absence of sputum
?possible fever and weightloss
What would you expect to find on examination in bronchieactasis?
- Finger clubbing - increase secretion growth factors - increased growth extracellular matrix nails.
- Coarse crepitations - expiration and inspiration - caused by sudden opening/closing airways.
- Rhonchi - low pitched noises like snoring - movement secretions in airways
- High pitched inspiratory squeaks and pops.
When should you suspect bronchieactasis in adults?
- Persistent production of mucopurulent or purulent sputum, esp when RF.
- Cough >8 weeks esp w sputum production or history trigger
- RA or IBD –> when have symptoms of chronic productive cough or recurrent chest infections.
- COPD when don’t smoke or those w COPD and frequent exacerbations w +ve culture psuedomona.
What are the investigations for bronchieactasis?
What would you expect to see on CXR?
Which investigation is diagnostic?
Bloods –> FBC increase. WBC and CRP in infection. Possible autoimmune screen w includes anti-CCP, ANA and ANCA. Possible congenital testing.
- CXR –> Can be normal in mild. In severe can be tram lines and ring shadows.
- DIAGNOSIS –> high resolution CT –> bronchial dilatation w or w/o wall thickening, mucuous plugged small airways, fluid filled cysts
- Spirometry –> obstructive –> decrease FEV1 and <0.7 FEV1/FVC ratio. Can be normal.
- Sputum culture –> MC and S
- Bronchoscopy when localised bronchieactasis and suspected foreign body
- Investigate cause –> e.g serum a-1, RF, HIV test, CF sweat test
What are the basics of conservative management in bronchieactasis?
diagnosis and determine the underlying cause.
Conservative
- Pul rehab –> refer to respiratory phsio – airway clearance techniques. Postural drainage.
- Smoking cessation
- Annual influenza vaccine and single pneumococcal.
What are the medical and surgical management options in bronchieactasis?
What is the Ab during exacerbations?
What is the Ab for prophylaxis?
- Mucoactive agents –> nebulised saline and carbocisteine –> aid sputum clearance in those w difficulty e.g frail elderly.
- Bronchodilators –> long acting e.g formoterol in those w activity limiting SOB
- Long term prophylactic Ab –> when freq exac >3 per year –> azithromycin x3 week
- Exacerbations –> most can be managed in primary care –> use past microbiology cultures to guide choice –> Therapeutic –> Ab, long courses >14 days are needed –> Ab according to bacterial sensitivity –> empirical amoxi 1st line or quinolone when colonised w pseudomonas
- Long term O2 if sats <88% on room air.
- Specific Tx underlying condition e.g CTFR modulator Trikafta in CF.
Surgical
- Lung resection of affected lobe/when localised and not controlled by optimum medical
- Lung transplant <65 w rapid deterioration despite medical e.g FEV1 <30% predicted.
