Define bronchiectasis
An obstructive lung disease which is caused by chronic inflammation of bronchi and bronchioles; characterised by mucus plugs and airway dilation
What are the common (primary & secondary) causes of bronchiectasis?
Any condition that causes chronic inflammation or recurrent pneumonia, such as: - Post-infective; often in childhood (40%) - Primary Ciliary Dyskinesia - Cystic fibrosis - Tumour/FB obstruction - Aspergillosis - Asthma - COPD - GORD/sinusitis - Rheumatoid arthritis or IBD BUT: 50% of cases are idiopathic
What are common complications of bronchiectasis?
- Hypoxia
- PAH
- Cor Pulmonale & RHF
- Pleurisy
- Empyema or lung abscess
- Clubbing
- Heamoptysis (rare)
What are the symptoms of an exacerbation of bronchiectasis?
- Increased wheezing and coughing
- Increase sputum/mucus production
- Increasing SOB
What would you expect to see on HRCT for a patient with bronchiectasis?
- Dilated bronchi/bronchioles (greater than accompanying pulmonary artery)
- Signet ring sign
- Air-fluid levels within airways
What would you expect to see on spirometry with a patient with bronchiectasis?
Commonly you’ll see an obstructive pattern:
- Decreased lung capacity
- Reduced FEV1
What are the medical foundations of treatment?
- Antibiotics for symptomatic exacerbations
- Consider prophylactic macrolide if >3x exacerbations per year
- Percussion/drainage to prevent mucus plugging or localised surgical management
- NOT for inhaled steroid but SABAs can be used for symptomatic relief
Define mycobacterium avium complex
- 3 different bacteria species, different to tuberculosis
- Known to be difficult to eradicate; often associated with chronic lung disease
- Slow growing, aerobic acid fast bacteria which infect macrophages
- Well known cause of nodular/cavitary bronchiectasis
- Can disseminate to other organ systems
How should you treat pulmonary myobacterium?
Treat with macrolide (azithromycin) + rifampin for up to 12 months
What are the symptoms of bronchiectasis?
- Chronic cough
- Sputum production
- Recurrent chest infections
- No history of smoking
- Finger clubbing
What pathogens are commonly isolated in patients with bronchiectasis?
- Strep. pneumoniae
- Haemophilus influenzae
- Staph aureus
- Pseudomonas
What investigations could you consider in a patient with bronchiectasis?
- Immunoglobulin studies (IgG, IgA, IgM, IgE)
- Asperigillus serology
- Sputum sample (including three samples for MAC)
- Sweat test
- Cilia function studies
What antibiotics should you use for an exacerbation?
- Augmentin 625mg TDS or Roxithromycin 300mg OD (if allergic) for 7-14 days total
- Ciprofloxacin 500mg BD if pseudomonas is the causative agent.
- NOT for steroids
What are common DDx for bronchiectasis?
- Chronic bronchitis
- COPD
- TB
What are the non–pharmacological treatment options for bronchiectasis?
- Sputum drainage
- Pulmonary rehabilitation with chest physio
- Vaccination (flu and pneumococcal)
- Smoking cessation
- Home oxygen in severe cases of hypoxia
