Bronchiectasis

What is bronchiectasis according to the summary?

An irreversible and abnormal dilation in the bronchial tree caused by cycles of bronchial inflammation leading to mucous plugging and progressive airway destruction. Summary 1

How is bronchiectasis classified based on etiology according to the summary?

Classified as either cystic fibrosis (CF) bronchiectasis or non-CF bronchiectasis (e.g., secondary to infection, immunodeficiency, COPD). Summary 2

What is the characteristic clinical feature of bronchiectasis mentioned in the summary?

A chronic cough with copious mucopurulent sputum. Summary 3

What other symptoms may occur with bronchiectasis besides chronic cough?

Dyspnea, rhinosinusitis, and hemoptysis. Summary 4

What auscultation findings are common in bronchiectasis?

Physical examination reveals crackles and rhonchi on auscultation, often accompanied by wheezing. Summary 5

What imaging modality confirms the diagnosis of bronchiectasis according to the summary?

High-resolution computed tomography (HRCT) confirms the diagnosis. Summary 6

What are characteristic signs of bronchiectasis on HRCT mentioned in the summary?

Thickened bronchial walls, with so-called "signet-ring" and "tram track" signs. Summary 7

What is an acute exacerbation of bronchiectasis, and how is it commonly treated?

An acute worsening of symptoms, commonly requiring antibiotic treatment. Summary 8

What is the goal of long-term management for bronchiectasis?

To control symptoms and prevent exacerbations. Summary 9

What does long-term management of bronchiectasis include according to the summary?

Pulmonary physiotherapy and pharmacological therapy. Summary 10

What intervention may be required for massive hemoptysis, a rare complication of bronchiectasis?

Surgery or pulmonary artery embolization may be required. Summary 11

How is bronchiectasis formally defined?

An irreversible and abnormal dilation of the bronchial tree that produces chronic respiratory symptoms (e.g., chronic productive cough). Definitions 12

How is an acute exacerbation of bronchiectasis defined?

A deterioration in the symptoms of bronchiectasis that requires a change in regular treatment (e.g., adding antibiotics, increasing airway clearance techniques). Definitions 13

What two processes are required for bronchiectasis to develop?

The combination of local infection or inflammation along with either inadequate clearance of secretions, airway obstruction, or impaired host defenses. Etiology 14

List three categories of conditions that can lead to non-CF bronchiectasis.

Pulmonary infections, disorders of secretion clearance/mucous plugging (PCD, ABPA, smoking), bronchial obstruction (COPD, aspiration, tumor, AATD), immunodeficiency (CVID, HIV), chronic inflammation (RA, Sjogren, Crohn). (Any 3) Etiology 15

What is the most characteristic clinical feature of bronchiectasis?

Chronic productive cough (lasting months to years) with copious mucopurulent sputum. Clinical Features 16

Besides cough, what other respiratory symptoms are common in bronchiectasis?

Dyspnea and hemoptysis (usually mild). Clinical Features 17

What findings are typical on lung auscultation in bronchiectasis?

Crackles and rhonchi; wheezing and bronchophony may also be present. Clinical Features 18

What non-respiratory symptom is often associated with bronchiectasis?

Rhinosinusitis. Clinical Features 19

What features characterize an acute exacerbation of bronchiectasis?

Increased mucous production above baseline, low-grade fever, and potentially worsening local or systemic symptoms (malaise). Clinical Features 20

What pathogen frequently causes acute exacerbations of bronchiectasis?

Pseudomonas aeruginosa frequently causes exacerbations. Clinical Features 21

What clinical scenarios should raise suspicion for bronchiectasis?

Poor control/frequent exacerbations in known COPD/asthma; chronic cough/recurrent infections in immunosuppressed/at-risk patients; productive cough > 8 weeks in otherwise healthy patients. Diagnosis 22

What is the best initial imaging test for suspected bronchiectasis?

Chest x-ray (though it may not show mild disease). Diagnosis 23

What is the confirmatory imaging test for bronchiectasis?

High-resolution computed tomography (HRCT) of the chest. Diagnosis 24

What are characteristic HRCT findings of bronchiectasis?

Bronchial dilation (cylindrical, varicose, or cystic/saccular types) and thickened bronchial walls. Diagnosis 25

What specific HRCT signs indicate bronchial dilation in bronchiectasis?

Parallel "tram track" sign (thickened, non-tapering parallel walls) and "signet ring" sign (dilated bronchus larger than adjacent pulmonary artery). Diagnosis 26

What laboratory tests are part of the initial workup for identifying the etiology of non-CF bronchiectasis?

CBC, quantitative serum immunoglobulins (IgA, IgG, IgM, subclasses), and Aspergillus fumigatus IgG and IgE (for ABPA). Diagnosis 27

What type of sputum analysis is recommended in the initial workup of bronchiectasis?

Sputum culture and smear for bacteria (e.g., H. influenzae, P. aeruginosa), fungi (Candida, Aspergillus), and mycobacteria (TB and NTM) via induced sputum or BAL. Diagnosis 28

How are pulmonary function tests (spirometry) used in bronchiectasis diagnosis and management?

Not needed for diagnosis, but useful to monitor disease progression; often shows a mixed obstructive/restrictive pattern, or isolated obstructive or restrictive patterns. Diagnosis 29

If initial workup for non-CF bronchiectasis is unrevealing, what additional tests might be considered based on clinical suspicion?

Specific antibodies (RF, ANA, ANCA), sweat chloride test/CFTR genetics, HIV test, α1-antitrypsin levels, nasal nitric oxide (PCD), bronchoscopy, GI studies (GERD/aspiration), colonoscopy (IBD). Diagnosis 30

What is the immediate management approach for an acute exacerbation of bronchiectasis?

Supportive treatment (oxygen if needed), optimize mucoactive agents and airway clearance, obtain new sputum culture, start empiric antibiotics (tailor to culture), complete ~14 days therapy. Management (Acute Ex) 31

What are the long-term management goals for bronchiectasis?

Stop/delay progression, reduce exacerbation frequency (goal ≤ 2/year), control symptoms, and improve quality of life. Management (Long) 32

What general measures are part of long-term bronchiectasis management?

Patient education, lifestyle changes (exercise, smoking cessation), vaccinations (influenza, pneumococcal), airway clearance techniques. Management (Long) 33

What are examples of airway clearance techniques used in bronchiectasis?

Bronchopulmonary hygiene and chest physiotherapy techniques like cupping/clapping, postural drainage, directed cough, and hydration. Management (Long) 34

What medications might be considered to aid airway clearance in bronchiectasis if needed?

Mucoactive agents, bronchodilators, or corticosteroids. Management (Long) 35

When is long-term antibiotic therapy considered for bronchiectasis, and what is the goal?

Consider for patients with ≥ 3 exacerbations per year. Goal is to suppress bacterial growth and reduce symptoms/exacerbations (secondary prevention). Management (Long) 36

When might surgical resection be indicated for bronchiectasis?

Indicated for pulmonary hemorrhage, inviable bronchus, or poor symptom control despite optimal medical therapy in well-localized unilateral disease. Management (Long) 37

What intervention is indicated for massive pulmonary hemorrhage in bronchiectasis?

Pulmonary artery embolization or surgical resection. Management (Long) 38

What are the major complications of bronchiectasis?

Recurrent infections leading to COPD, respiratory failure, cor pulmonale; pulmonary hemorrhage (massive hemoptysis); lung abscess. Complications 39