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Bronchiectasis History-Taking

 
 
 
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Overview

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  • Diagnosis - when the diagnosis was made, cause
  • Exercise tolerance
  • Frequency of exacerbations
  • Colonisation - bacteria that have been isolated in the past (e.g. Moraxella, Haemophilus, Pseudomonas, Staphylococcus aureus, Burkholderia cepacia, Mycobacterium)
  • Complications - infections, haemorrhage, cor pulmonale
  • Management - sputum clearance strategies, long-term antibiotics
  • 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

Complications

  • 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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