Bronchiectasis

Question 1

Bronchiectasis definition

Answer 1

Is the dilation of the bronchi when their walls become inflamed, thickened and irreversibly damaged

Usually follows obstruction, followed by infection

Question 2

Bronchiectasis predisposing factors

Answer 2

Whooping cough
Measles
TB
Inhaled foreign body
Bronchial carcinoma
Cystic fibrosis
Congenital ciliary dysfunction

Question 3

Clinical features bronchiectasis

Answer 3

Chronic cough worse in morning
Episodes of pneumonia
Sputum production related to posture
HAemoptysis
Coarse crackles in lung bases
Mild cases - yellow/green sputum only after infection
Severe cases:
Copious amounts of offensive purulent sputum, recurrent febrile episodes, malaise, weight loss

Question 4

Investigations in bronchiectasis

Answer 4

CXR - will be normal, or show bronchial changes

Sputum examination - for resistent pathogens and to rule out TB

Cytology - to rule out neoplasia

CT scan - shows bronchial wall thickening –> High resolution CT scan is new gold standard for diagnosis

Question 5

Most common pathogens in bronchiectasis

Answer 5

Step pneumoniae, pseudomonas auriginosa, haem influenzae

Question 6

Bronchiectasis management

Answer 6

Explanation of disease and prevetative advice

Posutral drainage - lie over side of bed with head and thorax downward for 10-20 mins, tid

Abx according to organism - important to treat any infection to prevent progression of disease

Bronchodilators - if evidence of bronchospasm