5 Things Respiratory Therapists Should Know About Bronchiectasis -

RRT Board Exam Alert! The NBRC recently updated the RRT board exam simulation content respiratory therapy students will be tested on beginning January 15, 2020. One of the changes includes the addition of bronchiectasis into the simulations. Though bronchiectasis was included in some previous RRT exam versions, it is now a guaranteed part of the clinical simulations.

1. What is bronchiectasis?

Bronchiectasis is an abnormal dilation and thickening of the bronchial walls of the small airways as a result of chronic infection and inflammation. Bronchiectasis is caused by whole-body systemic diseases such as:

COPD
Cystic fibrosis
Rheumatoid arthritis
Aspergillosis
Alpha-1 antitrypsin deficiency
Chron’s disease, or ulcerative colitis

The NBRC categorizes bronchiectasis on the RRT board exams as either cystic fibrosis bronchiectasis, or non-cystic fibrosis bronchiectasis (NCFB). Up to 50% of NCFB cases are idiopathic (they have no known cause).

2. What are the symptoms of bronchiectasis?

Chronic productive cough for copious amounts of purulent sputum.
Frequent pulmonary infections.
Green, foul smelling or fetid sputum which may settle in layers if expectorated into a cup.
Pseudomonas aeruginosa and MRSA are commonly found in the patient’s sputum culture.
Symptoms may resolve slowly or only partially over time.

3. How is bronchiectasis diagnosed?

Chest radiograph and a good medical history may lead you to suspect the patient has bronchiectasis. However, the gold standard for diagnosis of bronchiectasis is via CT-scan of the chest

CT-scan of the chest is the gold standard for diagnosis of NCFB (remember to keep in mind that a CT-scan is a time consuming test that should not be performed on the RRT board exam if the patient is unstable. Also, do not order a CT-scan of the chest if a chest radiograph has not yet been performed).
Sputum culture and sensitivity to check for bacteria and microbes commonly associated with bronchiectasis.

4. Is bronchiectasis curable?

Unfortunately, the damage to the lungs associated with bronchiectasis cannot be reversed. As a result, the main focus of treatment is to improve the patients symptoms and reduce the frequency of exacerbations.

5. How is bronchiectasis treated?

The following treatments may be considered to reduce symptoms and exacerbations of patients with bronchiectasis:

High Frequency Chest Wall Oscillation (HFCWO) can be performed both in and outside the hospital. This is a better alternative for patients being discharged home alone because, unlike with manual chest physiotherapy, it doesn’t require a caregiver.
Oscillatory PEP therapy
Chest physiotherapy with postural drainage (in hospital only)
Antibiotics: Psuedomonas aeruginosa and MRSA are often found in the thick mucus produced inside the airways of patients with bronchiectasis.
Inhaled corticosteroids may help if the patient has underlying COPD
Dornase alfa (Pulmonzyme) may be given via nebulizer to patients with Non Cystic Fibrosis Bronchiectasis (NCFB) to help break up the mucus.