Resp - bronchiectasis

Question 1

what is Bronchiectasis

Answer 1

a condition where the airways in the lungs become widened, scarred, and damaged, leading to a chronic wet cough and recurrent infections

Question 2

causes of bronchiectasis

Answer 2

Idiopathic
Pneumonia
Whooping cough
Tuberculosis
Alpha-1-antitrypsin deficiency
Connective tissue disorders (e.g., rheumatoid arthritis)
Cystic fibrosis
Yellow nail syndrome

Question 3

how is yellow nail syndrome characterised

Answer 3

by yellow fingernails, bronchiectasis and lymphoedema.

Question 4

sx of bronchiectasis

Answer 4

Shortness of breath
Chronic productive cough
Recurrent chest infections
Weight loss

Question 5

bronchiestsis signs on exam

Answer 5

• Sputum pot by the bedside
  -Oxygen therapy (if needed)
• Weight loss (cachexia)
• Finger clubbing
  Signs of cor pulmonale (e.g., raised JVP and peripheral oedema)
• Scattered crackles throughout the chest that change or clear with coughing
• Scattered wheezes and squeaks

Question 6

mc casuative organisms of bronchiectasis

Answer 6

Haemophilus influenza
Pseudomonas aeruginosa

Question 7

dx of bronchiectasis

Answer 7

1. sputum culture
2. chest x ray
3. High-resolution CT (HRCT) - gold standard

Question 8

chest x ray findings of bronchiectasis

Answer 8

Tram-track opacities (parallel markings of a side-view of the dilated airway)

Ring shadows (dilated airways seen end-on)

Question 9

tx of bronchiectasis

Answer 9

• Respiratory physiotherapy
• Pulmonary rehabilitation
• Long-term antibiotics (e.g., azithromycin) for frequent exacerbations (e.g., 3 or more per year)
• Inhaled colistin for Pseudomonas aeruginosa colonisation
• Long-acting bronchodilators may be considered for breathlessness
• long term o2 therapy

Question 10

last line tx of bronchiectasis

Answer 10

Surgical lung resection may be considered for specific areas of disease

Lung transplant is an option for end-stage disease

Question 11

what do infective exacerbations of bronchiectasis require

Answer 11

Sputum culture (before antibiotics)

Extended courses of antibiotics, usually 7–14 days

Ciprofloxacin is the usual choice for exacerbations caused by Pseudomonas aeruginosa

Question 12

key features of bronchiectasi

Answer 12

finger clubbing, diagnosis by HRCT,

Pseudomonas colonisation and extended courses of 7-14 days of antibiotics for exacerbations.