Bronchiectasis

Question 1

Pathophysiology?

Answer 1

When there is permanent dilatation of the airways secondary to chronic infection or inflammation.

Question 2

Causes?

Answer 2

• post-infective: tuberculosis, measles, pertussis, pneumonia
• cystic fibrosis
• bronchial obstruction e.g. lung cancer/foreign body
• immune deficiency: selective IgA, hypogammaglobulinaemia
• allergic bronchopulmonary aspergillosis (ABPA)
• ciliary dyskinetic syndromes: Kartagener’s syndrome, Young’s syndrome
• yellow nail syndrome

Question 3

What signs may be seen on imaging?

Answer 3

Tram lines and signet ring signs

Question 4

What are the most common organisms isolated from patients with bronchiectasis?

Answer 4

• Haemophilus influenzae (most common)
• Pseudomonas aeruginosa
• Klebsiella spp.
• Streptococcus pneumoniae

Question 5

Management?

Answer 5

• physical training (e.g. inspiratory muscle training) - has a good evidence base for patients with non-cystic fibrosis bronchiectasis
• postural drainage
• antibiotics for exacerbations + long-term rotating antibiotics in severe cases
• bronchodilators in selected cases
• immunisations
• surgery in selected cases (e.g. Localised disease)
• assess for treatable cause such as immune deficiency