Week Three - Case Four Flashcards
what is bronchiectasis
an obstructive lung disease
It is almost always a result of bronchial obstruction leading to infection with inflammation (distal to the obstruction)
what causes bronchiectasis
Cystic fibrosis – the most common cause in developed countries
Bordetella pertussis infections (Whooping Cough) can sometimes cause bronchiectasis later in life
Ciliary dysfunction syndromes
Primary hypogammaglobuminaemia
Congenital abnormalities (usually rare ones)
TB – this is the most common cause worldwide
what are the symptoms of bronchiectasis
chronic cough
production of large amounts of foul smelling sputum - may have flecks of blood
finger clubbing may be present
recurrent RTIs
fever and malaise
haemopytsis
what are the signs of bronchiectasis
May be unilateral or bilateral.
Coarse crackles (numerous) over areas containing large amounts of sputum
Possible collapse (no breath sounds)
Reduced or absent breath sounds at areas distal to places of obstruction
what is the pathology behind bronchiectasis
there will be destruction of the alveolar walls (and the elastin contained in them), with fibrosing of the remaining parenchyma.
what will then happen to the airway
the airway will then dilate as the surrounding scar tissue contracts. this can in itself cause secondary inflammatory changes which leads to further destruction of the airwaysw
where in the lungs is most greatly affected
usually the lower lobes are most greatly affected. this can lead to pooling of bronchial secretions, which increases the risk of further infections in this area. there will also be collections of pus
what may you find in a sputum sample
you may find pseudomonas aeruginosa, H influenzae, staph aureus, aspergillus fumigates, fungi (e.g. Aspergillus) and various mycobacteria
what may u see on a CXR in advanced disease
In advanced disease you may be able to see areas of thickened airway walls, cystic spaces, and consolidation or collapse.
what is the management of bronchiectasis the same as
the management of CF
what is essential in the management of bronchiectasis
Postural drainage – this is essential! Patients should be trained by physiotherapists in how to tip themselves into a position in which the affected lobe(s) is drained in an uppermost direction at least 3 times a day for 10-20 minutes – most patients find the most effective position is to lie down over the side of the bed with the head and thorax down
what are the most common antibiotics given in bronchiectasis
to halt progression of the disease you need to give adequate antibiotic therapy. This obviously depends on the infective organism:
Initially, try a broad spectrum, such as cefaclor or ciprofloxacin.
Try flucloxacillin 500mg every 6 hours if this fails. This is to treat staph aureus.
If the sputum remains yellow or green after regular phsyio and other AB’s, then it is likely the infective organism is P aeruginosa. This probably required inhaled AB’s, such as ceftazidime (which can also be given IV). You could also try inhaled cipro, but this creates resistance quickly.
what else may be given in the management of bronchiectasis (3 things)
steroids
bronchodilators
surgery
what are the complications of bronchiectasis
pneumonia
abscess
empyema
pulmonary fibrosis
cor pulmonale
metastatic absences in the brain
what plaques may form as a result of bronchiectasis
Amyloid plaques are insoluble fibrous protein aggregates. Their accumulation can lead to amyloidosis. A protein as described as being amyloid if it has a slightly altered structure, making it insoluble.
Amyloidosis can occur in many organs, and the symptoms vary greatly from organ to organ
what is the prognosis of bronchiectasis
This has greatly improved with antibiotic therapy. Ultimately, many patients die from respiratory failure due to deterioration of the lung tissue. Cor pulmonale is also common.
what are the features consistent on a CXR with bronchiectasis
- tram-track opacity
- mucus plugging
- ring shadow
- consolidation
what is bronchiectasis
is a chronic condition in which the bronchial tree becomes abnormally and irreversibly dilated. the bronchial walls become thickened and inflamed, leading to a build-up of excess mucus which can make the lungs vulnerable to infection
what are the causes of non-CF bronchiectasis
Idiopathic (most common)
Post-infective – e.g., bacterial pneumonia, mycobacterial infection
Allergic – e.g., to mould or fungus, especially in allergic bronchopulmonary aspergillosis (ABPA)
Autoimmune – associations with connective tissue diseases and inflammatory bowel disease
Immunodeficiency – e.g., primary ciliary dyskinesia, primary immunodeficiency disorders, HIV/AIDs
Obstruction – secondary to severe asthma or COPD, or distal to a neoplasm or inhaled foreign body
what is the epidemiology of bronchiectasis
An estimated 212,00 people in the UK are living with non-CF bronchiectasis
There is a female to male predominance
Incidence increases with age, with 60% of diagnoses made in the over-70 age group
Interestingly, bronchiectasis is more commonly diagnosed in the least deprived sections of the UK population, in contrast to other respiratory disorders
what is the investigations for Cystic fibrosis
sweat test and CFTR genetic testing
what does bronchoscopy test for
lung cancer
what does total IgE test for
ABPA
what does decal calprotectin test for
inflammatory bowel diseasew
what does immunoglobulins (IgG, IgA and IgM test for)
immunodeficiency
what is the treatment plan for bronchiectasis
Physiotherapy and airway clearance techniques
Cough assist devices
Smoking cessation: it is important for healthcare professionals to know what services are available to refer patients to, do you know how to find this information?
Pneumococcal and annual influenza vaccinations
Treatment with short courses of antibiotics for exacerbations or chest infections
In rare cases surgery, for example a lobectomy if bronchiectasis is localised and symptoms are debilitating
what can treat Moraxella catarrhalis and what is it resistant to
it is sensitive to co-amoxiclav and resistant to amoxicillin
what is the sail sign
a dense triangular opacity overlying the cardiac shadow
what is classed as an exacerbation of bronchiectasis
defined as deterioration in three or more of the following key respiratory symptoms for at least 48 hours
- cough
- sputum volume/consistency
- sputum purulence
- breathlessness
- fatigue and or malaise
- haemopysis
