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Bronchiectasis (Causes (Allergic bronchopulmonary aspergillosis -…
Bronchiectasis
Causes
Allergic bronchopulmonary aspergillosis - immunological over-response
HIV
Mechanical bronchial wall obstruction - foreign body, post TB stenosis, lymph node, tumour
Ulcerative colitis
Congenital - cystic fibrosis, deficiency of bronchial was elements, primary colliery dyskinesia
Hypogammaglobulinaemia
Post infection (most common) - previous pneumonia, granulomatous disease, measles, whooping cough, allergic broncho pulmonary aspergillosis, pertussis, bronchiolitis
Rheumatoid arthritis
Clinical Presentation
Wheeze
Infection usually characterised by increased sputum volume and increased purulence
Finger clubbing especially in cystic fibrosis
Dyspnoea
Chest pain
Chronic cough with production of copious amounts of foul smelling purulent sputum
Recurrent exacerbations with long recovery time
Usually the lower lobes are affected
Diagnosis
Spirometry - shows obstructive pattern
High resolution CT - thickened, dilated bronchi with cysts at the end of bronchioles & airways larger than associated blood vessels
Sinus X-rays - may have rhino sinusitis
Sweat test for all patients under 40, if cystic fibrosis suspected (will see high chloride concentration if CF)
Sputum culture - to see bacterial colonisation status, can be used to exclude non-tuberculous mycobacterial disease
Bronchoscopy to locate site of haemoptysis, exclude obstruction and obtain culture samples
CXR - Dilated bronchi with thickened walls, multiple cysts containing fluid showing up as cystic shadows
Immunology; e.g. total IgE to exclude bronchopulmonary aspergillosis
Key Facts
Bronchial walls become inflamed, thickened and irreversibly damaged
The mucocilliary transport mechanism is impaired and frequent bacterial infection ensue
Results from pulmonary inflammation and scarring due to infection, bronchial obstruction or lung fibrosis
Clinically the disease is characterised by productive cough with large amounts of discoloured sputum and dilated, thickened bronchi detected on CT
Chronic infection of the bronchi and bronchioles leading to permanent dilation of these airways
Treatment
Bronchodilators such as nebuliser salbutamol is useful for asthma or COPD sufferers
Antibiotics - type of antibiotic used depends on which microorganism is present
Anti-inflammatory agents e.g. long term azithromycin can reduce exacerbation frequency
Surgery in localised disease or to control severe haemoptysis
Improve mucus clearance - postural drainage, chest physio and mucolytics
Epidemiology
May develop after lung infections
It is the pathological end point of many diseases
More common in women than men
Present at any age but increased with age
Pathophysiology
Airways dilate due to pulmonary inflammation and scarring, as fibrosis contracts
Secondary inflammation changes lead to further destruction of airways
Failure of mucocilliary clearance and impaired immune function contribute to continued insult to bronchial wall
Differential Diagnosis
COPD, asthma, TB, chronic sinusitis, cough due to acid reflux, pneumonia, pulmonary fibrosis, cancer, inhalation of foreign body