Bronchiectasis

DEFINITION OF BRONCHIECTASIS

• It is a chronic and necrotizing condition of bronchi and bronchioles leading to their abnormal dilatations.

OR• Bronchiectasis is anatomically defined as

abnormal, irreversible dilatation and distortion of bronchi caused by inflammatory destruction of the muscular and elastic components of bronchi.

PREVALANCE OF BRONCHIECTASIS

• 52 per 100,000

CAUSES OF BRONCHIECTASIS

Bronchial obstruction• Tumor • Foreign body• Impaction of copious mucus (Asthma, Ch.

Bronchitis)

CAUSES OF BRONCHIECTASIS

• Chronic Respiratory Infection • Tuberculosis • Foreign body aspiration• Chronic cystic malformation• Immunodeficiency • Undiagnosed mass

CLINICAL FEATURES OF BRONCHIECTASIS

COUGH & SPUTUM:• Cough and mucopurulent sputum• Cough is invariably present and in many patients cough is

the only symptom for initial few years.• Sputum is Purulent, Tenacious and Foul smelling , more in

morning.HEMOPTYSIS:• Present in 40-70 % of patients and may vary from blood

streaks to large clots or significant fresh bleed. DRY BRONCHIECTASIS: • Cough with scanty sputum with or without hemoptysis.

CLINICAL FEATURES OF BRONCHIECTASIS

Acute Exacerbation:• Increasing cough• Increased Dyspnea• Increased volume of sputum production• Fever• Hemoptysis• Chest pain

BRONCHIECTASIS–CLINICAL EXAMINATION

Chest auscultation:• Prolonged expiration• Coarse crackles• Diffuse Rhonchi• Bronchial breathing in selected cases in

pneumonias.• Digital clubbing• Hypertrophic pulmonary osteoarthropathy• Cor pulmonale

DIAGNOSIS OF BRONCHIECTASIS

• History• Physical examination• X-ray Chest• Sputum cultures for bacteria, fungi and

mycobacteria.

BRONCHIECTASIS-CLINICAL FEATURES

• Cough• Fever• Copious amount of foul smelling sputum• Dilatation is permanent• Reversible dilatation occurs in viral and

bacterial pneumonia.

BRONCHECTASIS-GROSS MORPHOLOGY

• Affect lower lobes more• Often bilateral • More in air passages which are vertical• In tumor or foreign body impaction it is

localized or segmental• If more distal bronchi are involved more severe• Airways are usually four times dilated than

normal

BRONCHECTASIS-GROSS MORPHOLOGY

• Cylindrical- most common, tube like, increased in diameter

• Fusiform – spindle shaped dilatation• Saccular -sac like dilatation, like grapes.• Varicose- irregular bronchial dilatations and

tortuosities of bronchial passages. Imagine varicose veins.

• Cut sections show Honey Comb appearance

TRACTION BRONCHIECTASIS

• It is distortion of the airways secondary to mechanical traction on the bronchi from fibrosis of the surrounding lung parenchyma.for example after toxic gas exposure like by chlorine gas and ammonia, leads to irreversible damage to airways.

BRONCHIECTASIS-CHEST XRAY FINDINGS

• Increased pulmonary markings• Ring like structures• Atelectasis• Dilated and thickened airways (Tram lines)• Mucus plugging (Finger in glove appearance)

BRONCHIECTASIS-TREATMENT

• Controlling infection • Reducing inflammations• Improving bronchial hygiene

• Surgical resection of affected segment in selected patients.

BRONCHIECTASIS-TREATMENT

CONTROL OF INFECTION• Antibiotics for acute exacerbations• Prophylactic in few cases• Oral Flouroquinolones are commonest. Mostly

for 10-14 days.

BRONCHIECTASIS-TREATMENT

BRONCHIAL HYGIENE• Chest percussion• Postural drainage

• Mechanical vibration by ultrasonic devices• Positive expiratoty pressure• Flutter valve technique

BRONCHIECTASIS -TREATMENT

• In case of lack of response to treatment culture and sensitivity tests for sputum are done for better selection of antibiotics.

• May need injectible treatments• May need hospitalization

TREATMENT - BRONCHIECTASISMUCUS CLEARANCE

• Mucus hypersecretion is a prominent feature of bronchiectasis.

• Maintenance of adequate hydration by oral or intravenous fluids is helpful to avoid tenacious inspissated sputum retention.

• Humidification of air or oxygen is used as an adjunct to chest physiotherapy.

• Nebulization of normal or hypertonic saline• Use of acetyle cystine or other mucolytic agents

BRONCHIECTASIS –TREATMENT

BRONCHODILATORS• As there is airway obstruction and mucosal

hyperreactivity so bronchodilators are often used.

BRONCHIECTASIS-TREATMENT

ANTI-INFLAMMATORY AGENTS• Persistent endobronchial inflammation is

known to be play a significant role in pathophysiology of bronchiectasis so anti-inflammatory treatment may be beneficial.

BRONCHIECTASIS-TREATMENT

SURGERYFor • Symptoms control• Control of bleeding• Reduction of tenacious sputum production• Reduction of acute exacerbations• Improved quality of lifeSurgery of selected segments is indicated in :• Most severely affected segments• Recurrent bleeding segments• Segments harboring resistant tuberculosis or

other micro-organisms

BRONCHIECTASIS-TREATMENT MISCELLANEOUS

LUNG TRANSPLANT:• A viable option in selected cases

VACCINATIONS

STOP SMOKING

OXYGEN INHALATION

BRONCHIECTASIS-COMPLICATIONS

General • Hemoptysis• Toxemia • Amyloidosis• Septicemia• Septic shock• Metastatic

abscesses(Brain)

Lung •Lung abscess•Pneumonia•Pleuricy•Empyema•Cor pulmonale

CILIARY DYSKINESIA

• Immotile cilia syndrome• Kartagener’s Syndrome

CLINICAL FEATURES OF CILIARY DYSKINESIA

• Repeated bouts of otitis and sinusitis• Recurrent Chest Infection• Situs invertus (50%)

• Males- infertility

KARTAGENER’S SYNDROME

• Bronchiectasis• Sinusitis• Situs invertus• Male infertility