Bronchiectasis

Question 1

What is the Pathophysiology of Bronchiectasis?

Answer 1

An infectious insult ->host response -> transmural inflammation, mucosal edema, cratering, ulceration, neovascularization -> impaired drainage, permanent abnormal dilatation and destruction of the major bronchi and bronchiole walls

Question 2

What are the Etiology of Bronchiectasis?

Answer 2

-Airway obstruction (Foreign body aspiration, tumor)
-Defective host defenses
-Cystic fibrosis
-Dyskinetic cilia
-Allergic bronchopulmonary aspergillosis (ABPA)
-Cigarette smoking
-Rheumatic diseases
-Malignancy
-Non-tuberculous mycobacterial infection
-Other Pulmonary infections
Alpha-1-antitrypsin deficiency

Question 3

What are the Clinical Features of Bronchiectasis?

Answer 3

• Cough
• Daily production of mucopurulent and tenacious sputum x mos-yrs
• Hx repeated respiratory tract infections

Question 4

What are the Symptoms of Bronchiectasis?

Answer 4

• Cough with sputum
• Dyspnea
• Rhinosinusitis
• Hemoptysis
• Recurrent pleurisy
• Fatigue
• Urinary incontinence (stress incontinence)

Question 5

What are the Physical Exam findings of Brochiectasis?

Answer 5

• Chronic pulmonary crackles
• Wheezing
• Rarely digital clubbing

Question 6

What are the Laboratory Tests of Brochiectasis?

Answer 6

• Complete Blood Count (CBC) with differential
• Immunoglobulin quantitation (IgG, IgM and IgA to look for primary immunodeficiency disease)
• Antibody titers after pneumococcal vaccination (assess immune response to vaccination)
• Sputum gram stain & culture
• Sweat chloride testing (gold standard for diagnosing cystic fibrosis)

Question 7

What are the Brochiectasis Imaging studies?

Answer 7

• Chest X-ray

- Chest Computed tomography (CT)

Question 8

What are the Treatments of bronchiectasis?

Answer 8

-Treat the underlying disease
-Pneumonia or other infection (nontuberculous mycobacterial infections, allergic bronchopulmonary aspergillosis)
-HIV
-Prevent aspiration if possible
(Gastroesophageal reflux disease)
-Rheumatologic condition
-Immunizations

Question 9

What are the Treatments of acute exacerbations?

Answer 9

• Oral antibiotics (tailor to microscopy when culture data is available) x 10dys
• Outpatient vs inpatient treatment
• Nebulized hypertonic saline to thin secretions
• Chest Physiotherapy (chest PT)
• Oscillatory positive expiratory pressure (PEP) device to loosen secretions
• Bronchodilators (short acting beta-agonist)
• Pulmonary rehab