Bronchiectasis

Question 1

Definition of bronchiectasis

Answer 1

• Permanent dilation of bronchi due to destruction of the elastic and muscular components of the bronchial wall
• Often as a consequence of recurrent infections secondary to underlying disorder

Question 2

Risk factors for bronchiectasis

Answer 2

• CF
• Immunodeficiency
• Previous infections
• Congenital disorders of the bronchial airways
• Primary ciliary dyskinesia

Question 3

Presentation of bronchiectasis

Answer 3

• Cough
• Sputum
• Crackles, high pitched inspiratory squeaks and rhonchi
• Dysnpoea
• Fever
• Fatigue
• Haemoptysis
• Rhinosinusitis
• Weight loss
• Wheezing

Question 4

Diagnosis of bronchiectasis

Answer 4

• CXR - may be normal or show obscured hemidiaphragm, thin-walled ring shadows with or without fluid levels, tram lines, tubular or ovoid opacities
• HRCT - thickened, dilated airways with or without fluid levels, varicose constrictions along airways, cysts and/or tree-in-bud pattern
• FBC - raised WCC in infections
• Sputum cultures

Question 5

Management of bronchiectasis

Answer 5

• Exercise and improved nutrition
• Airway clearance therapy (PT)
• Inhaled bronchodilator
• Inhaled hyperosmolar agent (i.e. hypertonic saline)
• Long-term oral macrolide (i.e. azithromycin)
• Inhaled antibiotic (i.e. tobramycin)