What is bronchiectasis?
A long-term condition where the airways of the lungs become abnormally widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection
What is the pathological process in bronchiectasis?
Chronic inflammation of the bronchi and bronchioles, leading to pernament dilation and thinning of the airways.
What are the causes of bronchiectasis?
- Congential
- Post-infection
- Bronchial obstruction
- Allergic bronchopulmonary aspergillosis
- Hypogammaglobulinaemia
- Rheumatoid arthritis
- Ulcerative colitis
- Idiopathic
What are the congential causes of bronchiectasis?
- Cystic fibrosis
- Young’s syndrome
- Primary ciliary dyskinesia
What infections might bronchiectasis arise after?
- Measles
- Pertussis
- Bronchiolitis
- Pneumonia
- TB
- HIV
What might cause bronchial obstruction leading to bronchiectasis?
- Tumour
- Foreign body
What are the symptoms of bronchiectasis?
- Persistent cough
- Breathlessness
- Copious purulent sputum
- Intermittent haemoptysis
What investigations into bronchiectasis should be performed?
- History and examination
- Sputum culture
- HRCT chest
- Spirometry
- Bronchoscopy
What are the examination signs of bronchiectasis?
- Finger clubbing
- Coarse inspiratory crepitations
- Wheeze
What does the chest x-ray show in bronchiectasis?
- Cystic shadows
- Thickened bronchial walls
What is the purpose of bronchoscopy in bronchiectasis?
- Locate haemoptysis
- Exclude obstruction
- Obtain samples for culture
How is bronchiectasis managed?
- Airway clearance techniques and mucolytics
- Antibiotics
- Bronchodilators
- Surgery
What airway clearance techniques can be used in bronchiectasis?
- Active cycle of breathing techniques (ACBT)
- Postural drainage
What do active cycle of breathing techniques involve?
Repeating a cycle made up of a number of different steps, including a period of normal breathing, followed by deep breaths, then coughing up mucus. The cycle is repeated for 20 to 30 minutes
What is postural drainage?
Changing position to make it easier to remove mucus from the lungs
How do devices used in bronchiectasis work?
They use a combination of vibrations and air pressure to make it easier to cough out any mucus
Give three examples of devices used in bronchiectasis?
- Flutter
- RC cornet
- Acapella
When might antibiotics be used in bronchiectasis?
If there is an acute exacerbation
What antibiotics are given in an acute exacerbation of bronchiectasis?
A sample of sputum is used to determine bacterial sensitivity, however a broad spectrum antibiotic is used to cover until test results are available
When might antibiotics be given prophylactically in bronchiectasis?
If a patient has three or more infective exacerbations in a year, or if the symptoms during an infective exacerbation are particularly severe
When might bronchodilators be used in bronchiectasis?
In patients who have a particularly severe flare-up of symptoms. May also be useful in patients with COPD, asthma, CF, or ABPA
When might surgery be used in bronchiectasis?
- When only affecting one section of the lung
- Symptoms aren’t responding to treatment
- There is an underlying condiiton that might cause bronchiectasis to reoccur
What surgical treatment is used in focal bronchiectasis?
Lobectomy
What are the complications of bronchiectasis?
- Pneumonia
- Pleural effusion
- Pneumothorax
- Haemoptysis
- Cerebral abscess
- Amyloidosis
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[1] Bronchiectasis25
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[4] Asthma61
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[5] Atelectasis36
-
[7] Pleural Empyema18
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[9] Sarcoidosis52
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[10] Tuberculosis82
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[12] Pulmonary Aspergillus Infections27
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Idiopathic Pulmonary Fibrosis18
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Occupational Lung Disease22
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Pulmonary Vascular Disease24
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Respiratory Failure30
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Lung Cancer77
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Interstitial Lung Disease159
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Extrinsic allergic alveoltis17
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Asbestos-related lung disease (incl. asbestosis and mesothelioma)24
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Acute bronchitis11
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Obstructive sleep apnoea19
