What is bronchiectasis?
Permanent dilatation of bronchi
What is the main pathogenesis of bronchiectasis?
Chronic infection of bronchi and bronchioles
What are the main organisms causing bronchiectasis?
- H. influenzae
- Strep pneumo
- Staph aureus
- Pseudomonas aeruginosa
What are the congenital causes of bronchiectasis?
- 1. ciliary dyskinesia
- a. primary ciliary dyskinesia: immotile cilia
- b. kartaganers syndrome: immotile cilia, situs invertus, chronic sinusitis
- c. young’s syndrome: bronchiectasis and absent vas deferens
- 2. cystic fibrosis
- 3. Ig deficiency (IgG2, 4) due to recurrent infections
What are the acquired causes of bronchiectasis?
- 1. Post infective bronchial damage:
- a. Childhood infections: pertussis, measles, bronchiolitis
- b. TB
- c. HIV
- 2. Airway obstruction
- a. Inhaled foreign body
- b. Tumour
- c. Enlarged LN
- 3. Acquired immunodeficiency – AIDS (histoplasmosis fungal infection)
- 4. ABPA
- 5. RA
- 6. UC
What are the symptoms of bronchiectasis?
- Persistent cough
- Copious purulent sputum
- Intermittent haemoptysis
What are the signs of bronchiectasis?
- Finger clubbing
- Coarse inspiratory crepitations (lung bases usually)
What are the complications of bronchiectasis?
- Pleural effusion
- Cerebral abscess
- Eventually respiratory failure
Which Ix need to be done to diagnose bronchiectasis?
- Sputum culture
- Bronchoscopy – to locate site of haemoptysis or exclude obstruction
- Sweat test
What does CXR show in bronchiectasis?
- Dilated bronchi
- Thickened bronchial walls (tramline and ring shadows)
- Multiple cysts containing fluid → cystic shadows
What is the one investigation of choice to diagnose bronchiectasis and what does it show?
- airway dilatation,
- bronchial wall thickening,
- bronchial wall cysts
which investigations need to be done in an infective exacerbation of bronchiectasis?
What would spirometry show in bronchiectasis?
Is bronchiectasis usually confined or widespread?
- Usually widespread
- Confined to a lobe if due to inhaled foreign body or lobar pneumonia
What are the most frequently isolated organisms in bronchiectasis?
are pneumococcus and H. influenzae
how do TB and histoplasmosis (fungus, AIDS) cause bronchiectasis?
- Necrotizing inflammatory process
- Weakens bronchus wall
How do measles and pertussis cause bronchiectasis?
- Explosive coughing contribute to a dilatation of bronchial wall
- Weakened by inflamm process
How does allergic aspergillosis contribute to bronchiectasis?
- Ag-Ab complexes in bronchial wall
- Lead to inflamm reaction
- Wall destruction
what is the management of bronchiectasis?
- 1.postural drainage: bd
- 2.chest physio: aid sputum expectoriation and mucous drainage
- a.Staph aureus: flucloxacillin
- b.If pseudomonas then need oral ciprofloxacin or iv ceftazidime
- 4.bronchodilators eg salbutamol nebs if have asthma, COPD, CF, ABPA
- 5.corticosteroids eg prednisolone for ABPA
- 6.surgery if LOCALISED disease or to control severe haemoptysis