Bronchiectasis

Bronchiectasis describes persistent or recurrent bronchial sepsis related to irreversibly damaged and dilated bronchi (BTS definition)

It presents as:
  • chronic cough with large volumes of sputum
  • possibly haemoptysis

Clinically look for finger clubbing.
 
Causes of bronchiectasis include:
  • infective: post severe pneumonia, pertussis, TB
  • inflammatory: post gastric aspiration
  • congential: CF, Kartageners
  • immune-mediated
Conditions associated with bronchiectasis include:

Investigations:
  • serum immunoglobulins and electrophoresis
  • IgE to aspergillus fumigatus and aspergillus precipitins
  • CF investigations - sweat chloride and CFTR genetic mutation analysis
  • cilary investigation - saccharin test
  • bronchoscopy to exclude proximal obstruction
  • baseline CXR
  • HRCT - look for 'signet ring' = dilated bronchi larger than adjacent vascular bundle
  • sputum culture
  • lung function tests

Treatment:
  • physiotherapy - airway clearance techniques
  • bronchodilators if any obstruction
  • antibiotics for exacerbations
    • first line: amoxicillin, or clarithromycin if penicillin allergic
    • ciprofloxacin for those colonised with pseudomonas 
  • long-term antibiotics if 3 or more exacerbations per year; nebulised antibiotics should be considered
  • lung resection may be considered if localised disease and symptoms not controlled with medical management.

Complications
  • massive haemoptysis
  • cor pulmonale

0 comments:

Post a Comment

Comments? Corrections? Thoughts?