Bronchiectasis [Suppurative disorders] & Pneumonia [Infective disorders]

Define pneumonia.

An acute inflammatory condition of the lung parenchyma.

What happens to alveoli in pneumonia?

They fill partially or completely with fluid, inflammatory cells, exudate and cellular debris.

How is pneumonia classified by anatomical distribution?

Lobar pneumonia and bronchopneumonia.

How is pneumonia classified by place of acquisition?

Community-acquired (CAP), hospital-acquired/nosocomial, and ventilator-associated (VAP).

Give examples of pneumonia classified by cause.

Aspiration pneumonia and Pneumocystis pneumonia.

What is aspiration pneumonia?

Inhalation of oropharyngeal or gastric contents into the lower airways.

How can aspiration pneumonia cause infection?

It can introduce bacteria from the mouth and pharynx into the lower airways.

What complications can occur in aspiration pneumonia?

Purulent sputum, tissue necrosis, pulmonary cavities and lung abscess.

What cough symptoms may occur in pneumonia?

Cough with or without sputum or haemoptysis.

What type of chest pain may occur in pneumonia?

Pleuritic chest-wall pain.

What auscultation findings may occur in pneumonia?

Wheeze, crackles, bronchial breath sounds or decreased breath sounds.

What may a chest X-ray show in pneumonia?

An infiltrate or opacity.

What ABG change may occur in pneumonia?

Reduced PaO₂, indicating hypoxaemia.

Which constitutional symptoms may suggest acute pneumonia?

Fever, myalgia, malaise and tachycardia.

How does pneumonia impair gas exchange?

Fluid and inflammatory material in alveoli reduce effective gas-exchange surface and oxygen diffusion.

How does pneumonia affect respiratory cilia?

Infection damages the respiratory epithelium and impairs ciliary function, reducing mucus clearance.

How does pneumonia affect lung compliance?

Inflammation and fluid-filled alveoli make the lungs stiffer and harder to expand.

How can pleural inflammation affect breathing in pneumonia?

Pleuritic pain leads to shallow breaths and reduced tidal volume.

Why may coughing become less effective in pneumonia?

Pain and reduced cough effort limit secretion clearance, causing secretions to accumulate.

How can retained secretions affect pneumonia?

They obstruct airflow, reduce ventilation and worsen gas exchange.

What clinical consequences can result from impaired gas movement in pneumonia?

Low oxygen saturation, increased work of breathing, tachypnoea, dyspnoea and fatigue.

What is the medical treatment for pneumonia?

Pathogen-specific antibiotics when indicated, other medicines as appropriate, oxygen and higher-level care if severe.

When might steroids be used in pneumonia management?

In selected cases to reduce airway inflammation, depending on clinical presentation.

What determines physiotherapy management for pneumonia?

The individual presentation, severity and degree of respiratory compromise.

What physiotherapy interventions may help in pneumonia?

Airway-clearance techniques, cough augmentation if needed, deep breathing, positioning and mobilisation/exercise.

Define bronchiectasis.

Abnormal, irreversible dilation of bronchi due to destruction of elastic and muscular tissue from inflammation and infection.

What are the main structural changes in bronchiectasis?

Permanent bronchial/bronchiolar dilation, cilia loss, squamous metaplasia and mucous gland hyperplasia.

Can bronchiectasis be focal or diffuse?

Yes; it may affect a localised region or be widespread.

Which scan is best for diagnosing and monitoring bronchiectasis?

High-resolution CT (HRCT) is more useful than chest X-ray.

What may CT show in severe cystic-fibrosis-related bronchiectasis?

Grossly dilated airways and cystic changes, often prominent in the midlung zones.

What prevalence estimate was included in these notes for bronchiectasis?

Approximately 566 per 100,000; the true prevalence is uncertain.

Which sex is bronchiectasis reported to be more common in?

Women.

What trend in bronchiectasis prevalence was noted?

A reported increase of about 40% over the previous 10 years.

Which infection-related factor can cause bronchiectasis?

An untreated or poorly treated respiratory infection.

Which congenital disorders can predispose to bronchiectasis?

Conditions causing mucociliary dysfunction, including primary ciliary dyskinesia and cystic fibrosis.

What is Kartagener syndrome associated with?

Primary ciliary dyskinesia and an autosomal recessive inheritance pattern.

Which immune-related conditions can be associated with bronchiectasis?

Primary immune deficiencies and autoimmune diseases such as rheumatoid arthritis or inflammatory bowel disease.

How can airway obstruction cause bronchiectasis?

An inhaled foreign body or tumour can obstruct an airway and contribute to local damage.

How can aspiration contribute to bronchiectasis?

Recurrent aspiration, including from reflux, can cause airway inflammation and damage.

What is ABPA?

Allergic bronchopulmonary aspergillosis, a condition associated with bronchiectasis.

Which respiratory diseases may coexist with bronchiectasis?

COPD and asthma; associated numbers may be underreported.

Which infection may be associated with idiopathic bronchiectasis?

Nontuberculous mycobacteria (NTM).

What is a characteristic sputum symptom of bronchiectasis?

Chronic cough with excessive sputum, often over 30 mL per day.

What is the typical sputum character in bronchiectasis?

Often purulent; volume and consistency can vary.

Why can haemoptysis occur in bronchiectasis?

Inflammation of the airway mucosa can cause bleeding.

What is the significance of more than three bronchiectasis exacerbations per year?

Worse health status, greater likelihood of hospitalisation and increased mortality.

Why may bronchiectasis cause dyspnoea?

Hypoxaemia and increased airway resistance, among other factors.

What may be heard on auscultation in bronchiectasis?

Variable crackles and wheeze.

What spirometry pattern may occur in bronchiectasis?

A mixed obstructive and restrictive pattern may occur.

Why is HRCT preferred over CXR for bronchiectasis?

HRCT is better for diagnosis and monitoring disease progression.

Why is fatigue common in bronchiectasis?

The ongoing infection and inflammatory burden can contribute to energy loss.

What is the primary underlying problem in bronchiectasis?

Impaired mucociliary clearance, especially due to damaged or ineffective cilia.

How does impaired mucociliary clearance lead to chronic infection?

Retained mucus traps bacteria, allowing them to multiply and cause recurrent infection.

Describe the vicious cycle of bronchiectasis.

Mucus retention → infection → inflammation and airway damage → poorer clearance → further infection.

How does chronic infection affect surrounding lung tissue in bronchiectasis?

Ongoing inflammation may damage parenchyma and contribute to fibrosis.

How can fibrosis and inflammation affect gas exchange in bronchiectasis?

They can impair oxygen diffusion and reduce gas-exchange efficiency.

Why are dilated airways ineffective at clearing mucus?

Damaged, widened and sometimes floppy airways clear secretions poorly.

How do mucus plugs affect airflow in bronchiectasis?

They obstruct airflow and can reduce expiratory flow rate.

Why can expiration be difficult in bronchiectasis?

Damaged airways may collapse more easily during expiration, slowing airflow and trapping air.

What increases airway resistance in bronchiectasis?

Mucus narrowing the lumen, airway-wall inflammation and airway collapse.

What are the main goals of bronchiectasis management?

Improve wellbeing, control symptoms, improve quality of life, reduce exacerbations and limit lung-function decline.

Why is early, effective bronchiectasis management important?

It reduces short- and long-term morbidity.

What are core principles of bronchiectasis treatment?

Treat the cause, improve airway clearance, treat infection and monitor symptoms and exacerbations.

What should guide airway-clearance technique selection in bronchiectasis?

The individual's presentation and a sustainable long-term routine.

Which inhaled saline options were listed for bronchiectasis?

Normal saline 0.9% or hypertonic saline 3–6%, as clinically indicated.

What antibiotic durations were listed in the notes for bronchiectasis?

Oral antibiotics around 10 days; IV antibiotics around 5–14 days, depending on the case.

What should be monitored in bronchiectasis sputum?

Colour, volume, consistency and, when indicated, pathogens.

What self-management supports are useful in bronchiectasis?

Hydration, education, a written action plan and support for adherence.

What should regular physiotherapy review cover in bronchiectasis?

Airway-clearance and inhalation routines, exercise and response to treatment.

What additional rehabilitation and prevention measures may support bronchiectasis care?

Pulmonary rehabilitation and appropriate vaccinations.

How should treatment effectiveness be monitored in bronchiectasis?

Track symptoms, sputum and exacerbation frequency, alongside clinical review.