Bronchiectasis final
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Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.
Bronchiectasis final
- 1. BRONCHIECTASIS Dr. Aswini Kumar Mohapatra Professor & Head Dept. of Pulmonary Medicine
- 2. Definition : Characterized by chronic permanent and abnormal dilatation of bronchi, which contain cartilage and bronchial glands. It occurs due to destruction of the elastic and muscular components of the bronchial wall Chronic mucopurulent expectoration and recurrent acute pulmonary infections
- 3. Causes of Bronchiectasis : I. Congenital : - Cystic fibrosis - Ciliary dysfunction syndromes Primary ciliary dyskinesis Kartagener’s syndrome (Immotile cilia syndrome) (Sinusitis and transposition of the viscera) - Primary hypogammaglobulinemia
- 4. II. Acquired: A. Children - Pneumonia (complicating whooping cough and measles) Primary TB Inhaled foreign body B. Adults - Suppurative pneumonia Pulmonary TB Allergic bronchopulmonary aspergillosis Bronchial tumours
- 5. Pathogenesis : Infection and obstruction-two important key features Repeated pulmonary infections coupled with defective host defenses with impaired clearing mechanism Mechanical obstruction or obstruction due to muscus impaction impairs clearance leading to repeated infection
- 6. Vicious cycle of infection Obstruction infection goes on. Microorganisms attract neutrophils to the sites of inflammation Neutrophils Proteolytic enzymes Neutrophil elastase Epithelial damage Bronchial gland hyperplasia Connective tissue damage Bronchial distortion
- 7. Types: 1. Cylindrical or fusiform 2. Varicose 3. Cystic or saccular 4. Follicular
- 8. Symptoms: Cough: Chronic productive with purulent expectoration Halitosis ± Pneumonia and pleurisy-Due to inflammatory changes in the airways. Fever, malaise and increased cough and sputum volume. Chest pain and recurrent pleurisy in the same site Haemoptysis Poor personal health Extensive disease+ purulent sputum anorexia, weight loss, lassitude , low grade fever and failure thrive in children
- 9. Signs: May be unilateral or bilateral No secretions in the bronchiectatic airways no abnormal physical signs Large amount of secretions in the airways Coarse crackles Collapse with retained secretions blocking proximal bronchus. Diminished breath sounds Advanced Disease Dilatation of the bronchi bronchial breathing clubbing
- 10. Investigations: 1. Bacteriological and mycological examination of the sputum 2. Radiological examinations - A. Plain chest x-ray- ‘ring shadows’ or ‘honey coombing’ due to cystic dilated bronchi ‘tramline shadows’ or ‘band shadows’
- 11. B.Bronchography : Most accurate diagnostic procedure for evaluating Bronchiectasis, particularly when contemplating surgery. Contrast used- Dianosil Main indication is to find out whether apparently looking dilations show any evidence of Bronchiectasis, so that surgery can be or can not be undertaken replaced by CT-scan
- 12. C. HRCT thorax : Use of 1.0 to 1.5mm window every 1cm with acquisition times of one second Most sensitive and specific test for diagnosing Bronchiectasis
- 13. 3. Assessment of ciliary function: Pellets of saccharin placed in the anterior chamber of the nose to reach the pharynx, when patient can taste it. This time greatly prolonged in patients with ciliary dysfunction Structural abnormality of the Cilia detected by election microscopy
- 14. Management : 1.Chest physiotherapy/broncho-pulmonary hygiene - Helps in the drainage of excessive bronchial secretions Patient should adopt a position in which the lobe to be drained is uppermost Deep breathing followed by forced expiratory man oeuvres helps in moving secretions in the dilated bronchi towards the trachea, from which they can be cleared by vigorous coughing Percussion of the chest wall with cupped hands
- 15. Devices- o Positive expiratory pressure masks o flutter valve aid sputum clearance Duration - Optimum duration and frequency of physiotherapy depend on the amount of sputum. 5-10 minutes/once or twice daily Maintaining adequate systemic hydration
- 16. 2. Antibiotics Depend on the organisms isolated from the sputum. Most common bacteria:- H. influenzae P. aeruginosa S. aureus - Penicillin or ampicillin + aminoglycocide covers H.influenzae and S,.aureus - For pseudomonas –antibiotic therapy more challenging I.V ceftazidime (1-2gm/8hrly) Or Oral Ciprofloxain 250-750mg / 12hrly
- 17. 3. Surgery Role of surgery for Bronchiectasis has declined but not disappeared Indications - a) Failure of medical therapy with repeatd exacerbations b) Uncontrolled haemoptysis c) Obstructive lesions i.e. tumour surgery it contemplated , in whom the Bronchiectasis is unilateral and confined to a single lobe or segment on CT main stay of surgery resection of destroyed areas of lung which are acting as a reservoir of infection
- 18. Complications: Local Systemic Local : recurrent pneumonia Lung abscess Empyema Haemoptysis Pulmonary artery hypertension with Cor-pulmonale Congestive cardiac failure and Respiratory failure Systemic : Hypoproteinemia- generalised edema Amyloidosis-nephrotic syndrome due to secondary amyloidosis