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Lower Respiratory Disease
 
Lower Respiratory Disease
 

Bronchiectasis

 
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Pathogenesis

    • Causes of Bronchiectasis

    • Congenital

    • Cystic fibrosis
    • Primary ciliary dyskinesia (e.g. Kartegener’s syndrome)
    • Hypogammaglobulinaemia
    • Acquired

    • Recurrent pneumonia (e.g. in the setting of immunosuppression) - bacterial, tuberculous, fungal
    • Chronic obstructive pulmonary disease (COPD)
    • Allergic bronchopulmonary aspergillosis (ABPA)
    • Autoimmune diseases - rheumatoid arthritis, Sjogren’s syndrome, ulcerative colitis
    • Chronic aspiration (e.g. secondary to gastroesophageal reflux)
    • Airway foreign body

Manifestations

    • Complications of Bronchiectasis

    • Acute exacerbations
    • Pulmonary haemorrhage
    • Pneumothorax
    • Empyema
    • Lung abscess
    • Cor pulmonale

Diagnosis

    • Signs of Bronchiectasis

    • Oxygen requirement - reduced SpO2, nasal prongs
    • Halitosis
    • Cough - moist
    • Sputum - purulent / haemoptysis
    • Clubbing
    • Central cyanosis
    • Coarse crepitations
    • Wheeze
    • Signs of Complications

    • Evidence of empyema - dull percussion note, reduced breath sounds, reduced vocal resonance
    • Evidence of right ventricular failure - raised JVP, ascites, pleural effusions, peripheral oedema
    • Evidence of pulmonary hypertension - raised JVP, parasternal heave, loud / palpable P2
    • Complications of Bronchiectasis

    • Acute exacerbations
    • Pulmonary haemorrhage
    • Pneumothorax
    • Empyema
    • Lung abscess
    • Cor pulmonale

Management

    • Management Strategy

    • Treat the underlying cause
    • Sputum clearance - bronchodilators, mucolytics, hypertonic saline, physiotherapy, postural drainage
    • Reduce inflammation - using macrolides (azithromycin)
    • Manage infection - monitor for colonisation, consider antimicrobial prophylaxis
    • Vaccinations - influenza, pneumococcus
    • Nutritional support
    • Home oxygen
    • Lung transplant
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