Bronchiectasis

Question 1

What is Bronchiectasis?

Answer 1

Bronchiectasis is an obstructive airway disease due to chronic inflammation in the airway, resultin in dilate, thick wall bronchi

Question 2

When should bronchiectasis be suspected?

Answer 2

should be suspected in patients with a chronic cough that produces large amounts of sputum

Question 3

What is the epidemiology of bronchiectasis?

Answer 3

• Increasing , about 1 in 1.000, probably underestimated
• Women>Men (5.6:4.9)
• Prevalence increases with age (1.2% >70)

Question 4

What is the underlying pathophysiology of Bronchiectasis?

Answer 4

Impaired mucus clearing leading to –> recurrent Bacterial colonisation and chronic inflammation –>

Airway remodeling (fibrosis, loss of elastic elastin and ciliary epithelial cell damage) –> fibrosis and mucus plug

Question 5

What are symptoms of Bronchiectasis?

Answer 5

Persistent productive cough(often over many years) /on and off with

• SOB
• Haemoptysis
• Daily upbringing of purulent sputum (more severe)
• Non-pleuritic chest pain
• Absence of smoking

Question 6

What are signs of Bronchiectasis on examinaiton?

Answer 6

• Coarse crackles, especially in the lower lung zones.
• Wheeze.
• Large airway rhonchi (low pitched snore-like sounds).
• Finger clubbing
• Hypoxia + Pulmonary hypertension

Question 7

Which investigations should you consider in a patient with Bronchiectasis?

Answer 7

• Sputum culture (colonize bacteria)
• CXR
• Post-bronchodilator spirometry — to assess the severity of airflow obstruction
• Decreae FEV and lung capacity
• More in secondary care
  
  • E.g. genetic testing

Question 8

What are the XRay changes in a patient with Bronchiectasis?

Answer 8

• Exclude other causes
• Thickened bronchial walls
• Ring shadows (thickened airways seen end-on)
• Volume loss secondary to mucous plugging
• Air-fluid levels may be visible within dilated bronchi

Question 9

What are conservative managament options for Bronchiectasis?

Answer 9

• Smoking cessation
• Bronchopulmonary hygiene and chest physiotherapy
• Vaccinations
• Consider Bronchiodilaters in severe disease (not routinely)

Question 10

What would the management of an infectious exacerbation of bronchiectasis be?

Answer 10

• Consider Hosptital admission
• ABX

Question 11

What are possible complications that can develop in a Patient with Bronchiectasis?

Answer 11

• Infective exacerbation
  
  • ABX treatment
• Recurrent infections –> COPD –> Pulmonary Hypertension and Cor Pulmonale
• Pulmonary hemorrhage
• Resp- Failure
• Lung Abscess

Question 12

What is the prognosis for a patient with Bronchiectasis?

Answer 12

Varies widely

• Most people: few symptoms, normal life expectancy (expecially due to ABX)
• Some more severe: daily symptoms with progressive loss of lung function and reduced life expectance

Question 13

Which factors make a worse prognosis in a patient with bronchiectasis more likely?

Answer 13

• extensive disease.
• Has frequent exacerbations
• Has a primary antibody deficiency disorder
• Is colonized with Pseudomonas
• Smokes

Question 14

What are the inflammatory triggers that might lead to Bronchiectasis?

Answer 14

Actue

1. e.g. Severe lower tract resp. infection
   
   1. pneumonia, TB
2. Foreign body inhalation

Chronic

• Disorders of mucociliary clearance, or immunodeficiencies, that facilitate bacterial colonization of the lower respiratory tract.
• Endobronchial tumours
• Allergic bronchopulmonary aspergillosis
• ! Rheumatoid Arthritis
• Ulcerative Colitis
• Other congenital disorders (CF, Marfans, alpha1 antitrypsin deficiency)

Ideopathic (40%)