Bronchiectasis

Question 1

Bronchiectasis

Answer 1

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

Question 2

Clinical signs of Bronchiectasis

Answer 2

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 3

Investigation of Bronchiectasis

Answer 3

• 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)
  For a specific cause
• 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

Causes of bronchiectasis

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

Treatment of bronchiectasis

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

Complications of bronchiectasis

Answer 6

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