Sputum & Airways

Question 1

Describe the innate lung immune defence

Answer 1

Humoral - lactoferrin, lysozymes, defensins, complement

Cellular - alveolar macrophages, induced neutrophils

Question 2

Describe the adaptive lung immune defence

Answer 2

Humoral - B lymph, Plasma cells, Immunoglobulin

Cellular - Dendritic cells, T lymph

Question 3

What is Empyema?

Answer 3

Infection in pleura cavity

Question 4

What is Pneumonia?

Answer 4

Parenchymal lung inflam caused by infection

Question 5

What is bronchiectasis?

Answer 5

Dilated bronchi loose shape
Significant morbidity + mortality
Cycle of obstruction, inflam + infection = progressive irreversible lung damage = resp. failure

Question 6

Describe the pattern of deterioration in bronchiectasis

Answer 6

Bronchial wall inflam + destruction (infectious/toxin) >

Ciliary dyskinesia altered bronchial dynamics (genetics) >

Infective mucus clearance >

Chronic/recurrent infection (impaired immune system)

Question 7

What are the clinical features + signs of bronchiectasis?

Answer 7

• Cough - daily sputum production 75%
• Breathlessness
• Course crackles, wheeze
• Large airway rhonchi
• Clubbing
• Chest pain
• Haemoptysis
• Weight loss/ malaise/ low energy
• Sinus disease

Question 8

How is bronchiectasis treated?

Answer 8

• Airway clearance technique
• Mucolytic therapy
• Antimicrobial therapy
  LT antibiotics > reduces inflam > less exacerbations > improved HRQL
• Pulmonary rehab
• Immunisation against strep. pneumonia + seasonal influenza
• Record of sputum culture from previous exacerbations to guide future treatment