Station 1.7: Bronchiectasis

Question 1

Clinical signs

What are the clinical signs of Bronchiectasis?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 1

General: Cachexia and tachypnoea
Hands: Clubbing
Chest: Mixed character crackles that alter with coughing. Occasional squeaks
and wheeze. Sputum + + + (look in the pot!)
* Cor pulmonale: SOA, raised JVP, RV heave, loud P2
* Yellow nail syndrome: yellow nails and lymphoedema

Question 2

Discussions

How would you investigate Bronchiectasis?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 2

*  Sputum culture and cytology
*  CXR: tramlines and ring shadows
*  High‐resolution CT thorax: `signet ring’ sign (thickened, dilated bronchi larger than
the adjacent vascular bundle)

Question 3

Clinical signs

How would investigate Bronchiectasis for a specific cause?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 3

*  Immunoglobulins: hypogammaglobulinaemia (especially IgG2
and IgA)
* ** Aspergillus RAST or skin prick testing:** ABPA (upper lobe)
*  Rheumatoid serology
*  Saccharine ciliary motility test (nares to taste buds in 30 minutes): Kartagener’s
*  Genetic screening: cystic fibrosis
*  History of inflammatory bowel disease

Question 4

Clinical signs

What are causes of Bronchiectasis?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 4

Congenital:Kartagener’s and cystic fibrosis
Childhood infection: measles and TB
Immune OVER activity: allergic bronchopulmonary aspergillosis (ABPA); inflammatory
bowel disease associated
Immune UNDER activity: hypogammaglobulinaemia; CVID
Aspiration: chronic alcoholics and GORD; localized to right lower lobe

Question 5

Clinical signs

What treatment do you recommend for Bronchiectasis?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 5

*  Physiotherapy – active cycle breathing
*  Prompt antibiotic therapy for exacerbations
*  Long‐term treatment with low dose azithromycin three times per week
*  Bronchodilators/inhaled corticosteroids if there is any airflow obstruction
*  Surgery is occasionally used for localized disease

Question 6

Clinical signs

What are the complications of Bronchiectasis?

Bronchiectasis

This 60‐year‐old woman presents to your clinic with a persistent cough. Please examine her and
discuss your findings.

Answer 6

*  Cor pulmonale
*  (Secondary) amyloidosis (Dip urine for protein)
*  Massive haemoptysis (mycotic aneurysm)