BRONCHIECTASIS
DR. KAPIL RASTOGI
MP T (CAR DIOPUL MONARY)
A S S I S TA N T P R O F E S S O R
Definition
Bronchiectasis is a chronic inflammatory disease of the
lungs, defined as dilatation and destruction of bronchi and
bronchioles.
It results from impaired lung defence which results in
repeated infection, inflammation and destruction of the
airways.
Aetiology
Most cases follow recurrent episodes of respiratory
infections such as bronchitis, post measles or post
pertussis pulmonary infections, cystic fibrosis and
pneumonitis in infancy and early childhood.
Infections damage the bronchial wall and cause segmental
areas of collapse, which exert a negative pressure on the
damaged bronchi, causing them to dilate.
The bronchial dilation is widespread and patchy. The
bronchi may show cylindrical, fusiform or saccular
dilatation.
Types and prevalence of bronchiectasis
The condition most commonly affects the lower lobes, the
lingula and then the middle lobe.
It tends to affect the left lung more than the right,
although 50% of cases are bilateral.
The upper lobes are least affected as they drain most
efficiently with the assistance of gravity.
Broadly, there are two types of disease.
Congenital bronchiectasis
This is very rare and occurs in Kartagener’s syndrome
(‘immotile cilia’ syndrome) where there is a congenital
microtubular abnormality of the cilia that prevents normal
cilial beating.
It is characterised by bronchiectasis, sinusitis,
dextrocardia and complete visceral transposition. There
may also be associated male infertility.
Acquired bronchiectasis
Bronchial obstruction and bacterial infection are the principle
factors responsible for this disease. Obstruction of a bronchus,
which may be caused by a tumour or foreign body, will cause
collapse of the lung tissue supplied by that bronchus.
Bronchiectasis may also occur following an infection, which
causes the production of sticky sputum leading to obstruction
of multiple small bronchi.
Classically, this is associated with whooping cough,
tuberculosis, measles and pneumonia in childhood, when the
airways are smaller and therefore more easily ‘plug’ with
sputum.
Prevalence
The prevalence of bronchiectasis following a childhood
infection is decreasing as these infections are now treated
with antibiotics, but may occur in individuals with an
underlying disorder that predisposes them to chronic or
recurrent infection.
This includes cystic fibrosis, immunodeficiency, HIV
infection and primary ciliary dyskinesia.
Pathology
Bronchial obstruction may be localised (perhaps because of an
inhaled foreign body such as a peanut or broken tooth, or
obstruction caused by a tumour or enlarged gland) or generalised
(e.g. pneumonia that is slow to resolve owing to whooping cough
or measles).
The bronchial obstruction will cause absorption of the air from the
lung tissue distal to the obstruction and this area will therefore
shrink and collapse.
Secretions may collect distal to the obstruction if it is not relieved
quickly and these become easily infected.
This causes inflammation of the bronchial wall with destruction of
the elastic and muscular tissue.
Clinical features
Cough and sputum
Dyspnoea
Haemoptysis
Recurrent pneumonia
Chronic sinusitis
Suffer pyrexia
Night sweats
Anorexia
Malaise
Weight loss
Lassitude
Joint pains.
Prognosis of bronchiectasis
The vast majority of these patients can lead normal lives with a nearly
normal life expectancy provided the medical care is adequate.
However, possible complications are:
Recurrent haemoptysis (common);
Pneumonia (common);
Pleurisy and empyema;
Abscess formation (in lung/cerebrum) (rare);
Emphysema (rare);
Respiratory failure;
Right ventricular failure (commonly develops after years of pulmonary
sepsis and arterial hypoxaemia if there is widespread bronchiectasis).
Medical management
Control infection given antibiotics
Relieve the obstruction
Inhalation
Bronchodialetor
Analgesics
Physiotherapy management
To promote good general health and maintain or improve
exercise tolerance;
To remove secretions and clear lung fields;
To teach an appropriate sputum clearance regimen for
independent use;
To educate the patient in the pathology and management
of the condition
To teach the patient how to fit in home treatment within
his or her lifestyle.
Assessment
Demographic data
Name-
Age/gender-
Chief complains-
Address-
Occupation-
History –
Present history-
Past history-
Medical/surgical history-
Socio-economic history-
Occupational history-
Personal history-
On observation-
Consciousness-
Swelling-
Chest movement-
Chest deformity-
Use of assessory muscle-
Cyanosis- central/peripheral
On examination-
Air entry-
Breath sound-
Chest expansion-
Respiration rate-
Cough-
Sputum-
physiotherapy treatment
Percussion
Vibration
Thoracic expansion exercises
Active cycle of breathing techniques
Huffing and coughing
Respirometry
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