Bronchiectasis

Question 1

What is bronchiectasis

Answer 1

Chronic progressive lung contiion -> permanent bronchi dilation due to recurrent or severe LRTIs -> damage elastic and muscular brinchi walls

Question 2

Causes bronhciectasis

Answer 2

Recurrent/severe LRTIs/COVID/flu

Also:
CF
IBD - UC
Rheumatoid arthritis and other CTDs
HIV
Tumours
Allergic bronchopulmonary aspergillosis
Congenital defects eg marfans, williams

Question 3

Bacteria most common in bronchiectasis

Answer 3

H influenzae

Then:
Pseudomonas aerginuosa - 3x increase mortality
Moraxella
strep pneumoniae
S aureus
Enterobacteria
NTM

Question 4

Presentation broncheictasis

Answer 4

adults -
>8 weeks chronic productive cough w mucopurulent discharge
Large volume sputum
SOB
Fatigue
Fever
Weight loss
chest pain - not pleuritic
Youn
p/aureginosa
Non smoker
Haemoptysis
Rhinosinusitis
long history symptoms - uears

Question 5

What ass conditions make sus bronchiectasis w chronic productive cough

Answer 5

IBD - UC + CPC
RA + CPC
COPD +> 2 exacerbations annually +/- psuedomonas cultured when stable
poorly controlled astham

Question 6

Investigations - respiratory/basics

Answer 6

02 sats
Sputum culture
Spriometry
CXR baseline
FBC
weight
anx/depression

HIGH RES CT = gold standard

Question 7

Investigations for underlying causes bronchiectasis

Answer 7

CF - sweat test if <40
Antibodies - IgG, IgA, IgM deficiecnies, serum protein electrophoresis if high
serum IgE - ABPA
Antibodies against strep pneumonia
Primary ciliary dyskinersia
AntiCCP, ANA, ANCA, Rf
HIV
alha antitrypsin deficiency
Bronchsocopy - if localised to rule out tumor/foreign object
GI -UC

Question 8

When review bronchiectasis in seconadry care

Answer 8

> 3 exacerbations a year
P aeruginosa, NTM or MRSA +
Advanced or declining disease
Lung transplant
ABPA
Long term antibuotics
Ass RA, immunoderficiency, IBD, primary Ciliary Dyskineissia

Question 9

Management Broncheictasis

Answer 9

Annual review at GP:
MRC dyspnoea scale
Exaceratbations monitor
Sputum culture
02 and spirometry
Sputum clearance exercises
Immunisations - seasonal flu, COVID 19, strep pneumoniae
Stop smoking

Question 10

Infective exacerbation bronchiectasis when -> hospital

Answer 10

Cyanosis
Confusion
Peripheral oedema
Marked SOB
Temp over 38

Question 11

Treatment Infective exacerbation broncheictasis

Answer 11

Sputum culture - dont delay treat
Oral abx -> amoxicillin 7-14 days (clarithro or doxy alt)
LABA if SOB signficant
High risk -> Coamoxiclav or levofloxacin

Question 12

Complications bronchiectasis

Answer 12

Penumothorax
Haemoptysis >250 - life threat
Infective exacerbations
resp failure
Chest pain
Cor pulmonale, Corhonary HD, stroke
Anx/depression
Urinary incontinence
Fatigue
Nutritional deificiencies
Decrease QOL