This young man has This young man has long history of long history of productive cough and productive cough and wheezing. He is wheezing. He is afebrile and chest afebrile and chest auscultation reveals auscultation reveals coarse crackles at coarse crackles at right lower chest right lower chest

BRONCHIECTASISBRONCHIECTASIS

Bronciectasis (Greek word)Bronciectasis (Greek word)

•Bronkos ---- Wind pipeBronkos ---- Wind pipe•Ektesis ---- StretchingEktesis ---- Stretching

HOW DO YOU DEFINE BRONCHIECTASIS ?HOW DO YOU DEFINE BRONCHIECTASIS ?

Abnormal and permanent Abnormal and permanent dilatation of bronchi and dilatation of bronchi and

bronchioles greater than 2 mmbronchioles greater than 2 mm

BRONCHIECTASISBRONCHIECTASIS

CLASSIFICATIONCLASSIFICATION

REID’S CLASSIFICATION (1950)REID’S CLASSIFICATION (1950)

• Based on Pathology & BronchographyBased on Pathology & Bronchography CylindricalCylindrical VaricoseVaricose Saccular (Cystic)Saccular (Cystic)

Sacular type CylindricalSacular type Cylindrical

Varicose TypeVaricose Type

MUCOUS PLUGS

DILATED BRONCHIOLE

PATHOGENESIS PATHOGENESIS

BRONCHIAL INSULT

NORMAL HOST RESPONSE TO NORMAL HOST RESPONSE TO BRONCHIAL INSULT BRONCHIAL INSULT

INFLAMMATION

MUCOCILLIARY CLEARENCE

RETURN TO HEALTH

BRONCHIAL INSULT

ABNORMAL HOST RESPONSE TO ABNORMAL HOST RESPONSE TO BRONCHIAL INSULT BRONCHIAL INSULT

INFLAMMATION

IMPAIRED MUCOCILLIARY CLEARENCE

BRONCHIAL OBSTRUCTION

BRONCHIAL DAMAGE

FURTHER INFLAMMATION

BRONCHIECTASIS

PATHOGENESISPATHOGENESIS

OBSTRUCTION OBSTRUCTION INFLAMMATIONINFLAMMATION

ETIOLOGY OF ETIOLOGY OF BRONCHIECTASISBRONCHIECTASIS

CongenitalCongenitalAcquiredAcquired

Case StudyCase Study

While doing clinical elective in UK, While doing clinical elective in UK, you happen to see a young man, who you happen to see a young man, who has been regularly visiting chest has been regularly visiting chest clinic since birth with multiple clinic since birth with multiple admissions. He c/o productive cough admissions. He c/o productive cough and shortness of breath. His brother and shortness of breath. His brother also suffers from the same disease. also suffers from the same disease. His chest x-ray is His chest x-ray is

What is the What is the diagnosis ? diagnosis ?

What is mode of What is mode of inheritance ? inheritance ?

What do you see What do you see on this chest x-ray.on this chest x-ray.

What is pathology What is pathology

CYSTIC FIBROSIS CYSTIC FIBROSIS

What is the What is the diagnosis ? diagnosis ?

What is mode of What is mode of inheritance ? inheritance ?

What do you see What do you see on this chest x-ray.on this chest x-ray.

What is pathology What is pathology

Case StudyCase Study

30 Years old gentleman comes to you 30 Years old gentleman comes to you

with chronic sinusitis and productive with chronic sinusitis and productive

cough. His x-ray of sinuses and chest cough. His x-ray of sinuses and chest

areare

What is the diagnosis ? What is the diagnosis ?

Kartageyner Syndrome Kartageyner Syndrome

Primary ciliary dyskinesia (PCD)

or Kartagener Syndrome (KS), is a

rare, ciliopathic, autosomal recessive gene

tic disorder that causes a defect in the

action of the cilia lining the respiratory

tract (lower and pper, sinuses, Eustachian

tube,middle ear) and fallopian tube.

Kartageyner Syndrome Kartageyner Syndrome

It is combination of Ciliary Dyskinesia It is combination of Ciliary Dyskinesia and situs inversus (complete and situs inversus (complete or incomplete)or incomplete)

Infertility Infertility

What are the congenital causes What are the congenital causes of Bronchiectasis ? of Bronchiectasis ?

ETIOLOGY: ETIOLOGY: CONGENITALCONGENITAL

Cystic FibrosisCystic Fibrosis

Primary Ciliary DyskinesiaPrimary Ciliary Dyskinesia

Kartagener’s SyndromeKartagener’s Syndrome

Immunodeficiency StatesImmunodeficiency States

Intralobular Lung SequestrationIntralobular Lung Sequestration

AQUIRED CAUSES AQUIRED CAUSES

POST INFECTIOUSPOST INFECTIOUS

BRONCHIAL OBSTRUCTIONBRONCHIAL OBSTRUCTION

MISCELLANEOUS CONDITIONSMISCELLANEOUS CONDITIONS

AQUIRED CAUSES AQUIRED CAUSES POST INFECTIOUSPOST INFECTIOUS

BacterialBacterial Mycobacterium tuberculosisMycobacterium tuberculosis

Pseudomonas aureginosaPseudomonas aureginosa

Hemophillus influenzaeHemophillus influenzae

Staphylococcus aureusStaphylococcus aureus

AQUIRED CAUSES: AQUIRED CAUSES: POSTINFECTIOUS POSTINFECTIOUS

ViralViral AdenovirusAdenovirus InfluenzaInfluenza HIVHIV

FungalFungal Aspergillus fumigatus (ABPA) Aspergillus fumigatus (ABPA)

Allergic Bronchopulmonary Allergic Bronchopulmonary Aspergillosis (ABPA) Aspergillosis (ABPA)

Mainly in Mainly in AsthmaticsAsthmatics

Sensitization to Sensitization to aspergillousaspergillous

Raised IgE levelRaised IgE level Tubular Tubular

Bronchiectasis Bronchiectasis

ETIOLOGYETIOLOGY : : BRONCHIALBRONCHIAL OBSTRUCTION OBSTRUCTION

TumourTumour Foreign BodiesForeign Bodies Mucous PlugsMucous Plugs

ETIOLOGY: ETIOLOGY: OTHER CAUSES

Rheumatoid ArthritisRheumatoid Arthritis Inflammatory Bowel DiseaseInflammatory Bowel Disease Systemic Lupus ErythematosusSystemic Lupus Erythematosus Post transplantPost transplant

CLINICAL PRESENTATION

SYMPTOMSSYMPTOMS Persistent coughPersistent cough Purulent sputum Purulent sputum

(green and foul smelling)(green and foul smelling) HemoptysisHemoptysis WET TYPEWET TYPE DyspneaDyspnea WheezeWheeze FeverFever Severe PneumoniaSevere Pneumonia AsymptomaticAsymptomatic DRY TYPEDRY TYPE Non Productive CoughNon Productive Cough

CLINICAL PRESENTATI0NCLINICAL PRESENTATI0N

SIGNSSIGNS• On GPEOn GPE

Digital ClubbingDigital Clubbing CyanosisCyanosis PlethoraPlethora Muscle wastingMuscle wasting

• On AuscultationOn Auscultation CracklesCrackles WheezeWheeze RonchiRonchi

COMPLICATIONSCOMPLICATIONS

Recurrent pneumoniaRecurrent pneumonia EmpyemaEmpyema HaemoptysisHaemoptysis PneumothoraxPneumothorax Lung abscessLung abscess Brain abscessBrain abscess AmyloidosisAmyloidosis Cor pulmonaleCor pulmonale

DIAGNOSISDIAGNOSIS

CLINICAL PRESENTATIONCLINICAL PRESENTATION

SPUTUM ANALYSISSPUTUM ANALYSIS

RADIOLOGYRADIOLOGY

DIRECT VISUALISATIONDIRECT VISUALISATION

ESTABLISHMENT OF CAUSEESTABLISHMENT OF CAUSE

CLINICAL PRESENTATIONCLINICAL PRESENTATION

HISTORYHISTORY CLINICAL EXAMINATIONCLINICAL EXAMINATION RULE OUT RULE OUT

PneumoniaPneumonia EmphysemaEmphysema Lung abscessLung abscess

SPUTUM ANALYSISSPUTUM ANALYSIS

Amount of sputumAmount of sputum 24 hr Sputum Production24 hr Sputum Production

MildMild < 10 ml/day< 10 ml/day ModerateModerate <150 ml/day<150 ml/day SevereSevere >150 ml/day>150 ml/day

Visual ImpressionVisual Impression MicrobiologyMicrobiology

Streptococcus pneumoneaeStreptococcus pneumoneae Hemophillus influenzaeHemophillus influenzae Aspergillus Aspergillus PsedomonasPsedomonas E. coliE. coli

LAB TESTSLAB TESTS

Blood complete pictureBlood complete picture Quantitative immunoglobulinQuantitative immunoglobulin Alpha-1 anti-trypsin levelAlpha-1 anti-trypsin level

RADIOLOGYRADIOLOGY

Chest X-ray PA viewChest X-ray PA view CylindricalCylindrical VaricoseVaricose SaccularSaccular

BronchographyBronchography CT ScanCT Scan

DIRECT VISUALISATIONDIRECT VISUALISATION

BronchoscoyBronchoscoy

FlexibleFlexible

RigidRigid

ESTABLISHMENT OF CAUSEESTABLISHMENT OF CAUSE

Serum Protein electrophoresis Serum Protein electrophoresis

Serum ImmunoglobulinsSerum Immunoglobulins

Pilocarpine Iontophoresis (Sweat Test)Pilocarpine Iontophoresis (Sweat Test)

Aspergillus Precipitin TestAspergillus Precipitin Test

Electron MicroscopyElectron Microscopy

MANAGEMENTMANAGEMENT

4 GOALS4 GOALS Elimination of ProblemElimination of Problem

Clear Tracheo-bronchial SecretionsClear Tracheo-bronchial Secretions

Control InfectionsControl Infections

Reverse Airflow ObstructionReverse Airflow Obstruction

MANAGEMENT

POSTURAL DRAINAGEPOSTURAL DRAINAGE

BRONCHODIALATORSBRONCHODIALATORS

CORTICOSTEROIDSCORTICOSTEROIDS

TREAT INFECTIONSTREAT INFECTIONS

Antibiotics (according to C&S)Antibiotics (according to C&S) Amoxicillin 250mg Amoxicillin 250mg -------- TDS -------- TDS Co-amoxiclav 325mg -------- TDSCo-amoxiclav 325mg -------- TDS Levofloxacin 500mg -------- BDLevofloxacin 500mg -------- BD Ceftazidime Ceftazidime

Preventive and suppressive Preventive and suppressive antibioticsantibiotics

Other treatmentOther treatment

Inhaled Broncho dilators Inhaled Broncho dilators Inhaled aerosolized aminoglycosidesInhaled aerosolized aminoglycosides

SurgerySurgery

Reserved for patients with localised Reserved for patients with localised bronchiectasis and adequate lung bronchiectasis and adequate lung functions functions

Sometime in massive haemoptysisSometime in massive haemoptysis

PREVENTIONPREVENTION

VACCINATIONVACCINATION Influenza vaccineInfluenza vaccine

Pneumococcal vaccinePneumococcal vaccine

AVOID EXACERBATING FACTORSAVOID EXACERBATING FACTORS

Regular chest physiotherapyRegular chest physiotherapy

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