Bronchectesis is importent

1. BRONCHIECTASIS
Presentor : Dr. Habib Shafi Niazi
1401

2. INTRODUCTION
• Abnormal dilatation of the bronchi.
• Irrespective of cause, Chronic suppurative
airway infection with:
• Sputum production
• Progressive scarring
• Lung damage

3. ETIOLOGY
• Congenital
• Cystic fibrosis
• Ciliary dysfunction syndromes
• Primary ciliary dyskinesia (immotile cilia
syndrome
• Kartagener's syndrome (sinusitis and
transposition of the viscera)
• Primary hypogammaglobulinaemia

4. ETIOLOGY
• Acquired: children
• Pneumonia (complicating whooping cough or
measles)
• Primary TB
• Inhaled foreign body
• Acquired: adults
• Suppurative pneumonia
• Pulmonary TB
• Allergic bronchopulmonary aspergillosis complicating
asthma Bronchial tumours

6. PATHOLOGY
• Cavities may be lined by granulation tissue, squamous
epithelium or normal ciliated epithelium
• May also be inflammatory changes in the deeper layers of
the bronchial wall
• hypertrophy of the bronchial arteries.
• Chronic inflammatory and fibrotic changes are usually found
in the surrounding lung tissue
• All this factor results in progressive destruction of the normal
lung architecture in advanced cases.

7. CLINICAL FEATURES:
SYMPTOM
• Cough
• Chronic productive cough: accumulation of pus in dilated bronchi
• Usually worse in mornings and often brought on by changes
of posture.
• Sputum often copious and persistently purulent in advanced
disease
• Halitosis is a common accompanying feature
• Pneumonia and pleurisy
• Due to inflammatory changes in lung and pleura surrounding dilated
bronchi when spread of infection occurs
• fever, malaise and increased cough and sputum volume
• May be associated with pleurisy
• Recurrent pleurisy in the same site often occurs

8. CLINICAL FEATURES:
SYMPTOM
• Haemoptysis
• Can be slight or massive and is often recurrent.
• Usually associated with purulent sputum or an increase in
sputum purulence
• Can, however, be the only symptom in so-called 'dry
bronchiectasis'
• Poor general health
• When disease is extensive and sputum persistently purulent,
• There may be associated weight loss, anorexia, lassitude,
low-grade fever, and failure to thrive in children
• Digital clubbing is common

9. CLINICAL FEATURES:
PHYSICAL SIGNS
• May be found unilaterally or bilaterally in chest
• If the bronchiectatic airways
• do not contain secretions, no associated lobar collapse: no
abnormal physical signs.
• Large amounts of sputum - numerous coarse crackles
• Collapse with retained secretions blocking a proximal bronchus
may lead to locally diminished breath sounds
• Advanced disease may lead to scarring and overlying bronchial
breathing.
• Acute haemoptysis is an important complication

10. INVESTIGATIONS
• Radiological examination
• Unless very gross, is not usually apparent on a chest X-ray.
• Advanced disease, thickened airway walls, cystic bronchiectatic
spaces, and associated areas of pneumonic consolidation or
collapse may be visible
• CT is much more sensitive, and shows thickened dilated
airways
• Assessment of ciliary function
• Ciliary dysfunction syndrome
• Time taken for a small pellet of saccharin placed in anterior
chamber of the nose to reach the pharynx
• should not exceed 20 minutes
• Ciliary beat frequency - biopsies

11. INVESTIGATIONS
• Bacteriological and mycological examination of
sputum
• In addition to common respiratory pathogens,
sputum culture may reveal
• Pseudomonas aeruginosa
• fungi such as Aspergillus
• Various Mycobacteria
• Frequent cultures are necessary to ensure
appropriate treatment of resistant organisms

12. MANAGMENT
• Airway patency: inhaled bronchodilators and corticosteroids
• Physiotherapy - assist the drainage of excess bronchial secretions
– great value both in reducing the amount of cough and sputum
– preventing recurrent episodes of bronchopulmonary infection.
– Deep breathing followed by forced expiratory manœuvres
– Percussion of the chest wall with cupped hands - dislodge sput
um
– Devices which increase airway pressure
• Constant amount (positive expiratory pressure mask)
• oscillatory manner (flutter valve)
– Optimum duration and frequency
• amount of sputum
• 5-10 minutes once or twice daily is a minimum

13. MANAGMENT
• Antibiotic therapy
• Appropriate antibiotics
• larger doses and longer courses are required
• Resolution of symptoms is often incomplete - secondary
infection occurs with staphylococci and Gram-negative bacilli
• Pseudomonas - more challenging and should be guided by the
microbiological sensitivities - intravenous injection or infusion
• Ciprofloxacin (250-750 mg 12-hourly)
• Ceftazidime (1-2 g 8-hourly) may be required.
• Haemoptysis in bronchiectasis often responds to treating the
underlying infection
• Severe cases percutaneous embolisation of the bronchial
circulation by an interventional radiologist

14. SURGICAL TREATMENT
• Excision of bronchiectatic areas - a small proportion of cases.
• Usually young patients in whom the bronchiectasis is unilateral
and confined to a single lobe or segment on CT.
• Patient where medical treatment proves unsuccessful are also
unsuitable for surgery
• Either extensive bronchiectasis or coexisting chronic lung disease.
• In progressive forms of bronchiectasis, resection of destroyed
areas of lung
• reservoir of infection
• considered as a last resort

15. PROGNOSIS
• Poor in progressive disease when associated
with
• Ciliary dysfunction
• Cystic fibrosis
• Eventually causes respiratory failure.
• In other patients the prognosis can be relatively
good if
• physiotherapy is performed regularly
• antibiotics are used aggressively

16. PREVENTION
• Commonly starts in childhood following
• Measles
• Whooping cough
• Primary tuberculous infection,
• It is essential that these conditions receive adequate
prophylaxis and treatment.
• The early recognition and treatment of bronchial obstruction
is also important

17. THANKS
Any question?