Bronchiectasis

• What is bronchiectasis?


  Irreversibly dilated bronchi + chronic bronchial inflammation and infection
• What are some causes of bronchiectasis?

  Idiopathic

  Infection

  Immunodeficiency

  COPD

  Asthma
• What is localised bronchiectasis?

  Restricted to one lobe
• What is generalised bronchiectasis?

  Affects multiple lobes
• What are some signs and symptoms of bronchiectasis?

  Productive cough

  Recurrent chest infections

  Haemoptysis

  Dyspnoea
• What may a resp examination reveal for bronchiectasis?

  Crackles

  Wheeze

  Clubbing
• What does NICE recommend for the investigation of bronchiectasis?

  Sputum culture

  Chest X-ray

  Post-bronchodilator spirometry
• What are the most common colonising pathogens in a sputum culture for bronchiectasis?

  Haemophilus influenza

  Pseudomonas aeruginosa
• What is the most common pattern seen in post-bronchodilator spirometry in a patient with bronchiectasis?

  Obstructive pattern
• What should happen if a patient it suspected to have bronchiectasis?

  Referred to a resp consultant for confirmation
• What is the gold standard imaging for bronchiectasis diagnosis?

  High-resolution CT scan (HRCT)
• What are some CT findings for bronchiectasis?

  Bronchoarterial ratio >1

  Lack of tapering

  Bronchus visible within 1cm of pleural surface
• What does having a bronchoarterial ratio >1 mean?

  Internal airway lumen is larger than the adjacent pulmonary artery (also called signet ring sign)
• What does the BTS recommend after bronchiectasis is confirmed?

  FBC, serum total IgE and assessment of sensitisation to Aspergillus fumigatus - investigate for ABPA

  Serum IgG, IgA and IgM - investigate for immunodeficience
• How is bronchiectasis managed?

  Treat underlying cause

  Airway clearance techniques

  Flu vaccine

  Antibiotics (for exacerbations)

  Self-management plan
• What is the aim of teaching patients airway clearance techniques?

  Loosen and clear mucus from the lungs

  Improve ventilation

  Improve efficiency of cough
• Where should someone who has severe signs and symptoms of bronchiectasis be treated?

  Secondary care
• What does NICE recommend doing for patients managed within primary care?

  Sputum sample

  Antibiotics

  SABA

  Check airway clearance technique

  Review antibiotic response
• What surgical management can be done for those with localised bronchiectasis?

  Lung resection
• What surgical management can be done for those with diffuse bilateral bronchiectasis?

  Lung transplant
• What is the BTS criteria for lung transplant?

  Age - 65 or less

  FEV <30%

  Rapid progressive deterioration despite optimal medical management