Bronchiectasis

Question 1

Bronchiecstasis

Answer 1

Chronic lung disease, characterised by:
- irreversibly dilated bronchi
- bronchial inflammation and infection

Rare compared with diseases like COPD and asthma

Question 2

Main causes of bronchiecstasis

Answer 2

• idiopathic
• post-infection
• immunodeficiency
• COPD
• connective tissue disease
• yellow nail syndrome

Question 3

Pathophysiology of bronchiectasis

Answer 3

Can be:
- localised (one lobule)
- generalised (multiple lobules)

Coles ‘vicious cycle hypothesis’:
1. poor mucociliary clearance
2. microorganism colonisation and infection
3. chronic inflammation
4. dilation and thickening of bronchi
5. bronchial wall oedema, increased mucous production
6. further infections
7. further inflammation and damage

Question 4

Clinical features of bronchiectasis

Answer 4

• persistent productive cough
• daily sputum production
• haemoptysis
• recurrent chest infections
• rhinosinusitis symptoms (e.g. congestion)
• dyspnoea
• chest pain
• GORD

Question 5

Respiratory findings in bronchiectasis

Answer 5

• crackles
• wheeze
• finger clubbing

Question 6

Investigations in bronchiectasis

Answer 6

• sputum culture (haemophilus influenzae, pseudomonas aeruginosa)
• chest x-ray
• post-bronchodilator spirometry
• high resolution CT

Question 7

Bronchiectasis differentials

Answer 7

• COPD
• asthma
• lung cancer
• tuberculosis

Question 8

Managing bronchiectasis

Answer 8

• airway clearance techniques
• pulmonary rehabilitation
• antibiotics (via sputum sample)
• SABA
• surgical management (e.g. lung resections or transplant)

Question 9

Complications of bronchiectasis

Answer 9

• respiratory failure
• pulmonary infections
• haemoptysis
• pulmonary hypertension/cor pulmonale