THE VICIOUS CYLE

1. Dr. Ragulan M.D

2. • Abnormal, permanent and irreversible dilation of the
medium sized sub segmental bronchus from 5th to 9th
generation.

5. • Three common mechanisms
1) Atelectasis theory
2) pressure of Secretion theory
3) Traction theory

6. • Shown experimentally 60 years back
• Aspiration of materials into the peripheral part of the lung
might result in atelectasis
• This results in the dilation of the bronchi in the distal part
of the lung
• Generally this is compensatory and occurs generally
because of atelectasis
• Lander concluded with three possible theories

7. • The collapsed lung might re expand with the
disappearance of the bronchial dilatation such reversible
bronchiectasis is a reason not to diagnose this as
bronchiectasis
• The lung collapse and consequent bronchial dilatation
can be permanent
• The lungs might re expand with the bronchi remains
dilated because of the damage to their walls by an
infective process

8. • Plugging of bronchus with mucus or other material
• Secretions distal to the obstruction accumulate and
distend the bronchi beyond the block
• Experimentally possible only in the presence of the
bronchial wall inflammation

9. • Bronchial dilatation secondarily to fibrosis of lung
parenchyma
• High inflation pressure on inspiration to overcome
abnormally high retractive force
• Clearly not account for the bronchiectasis with little lung
parenchyma fibrosis
• Pathological findings of bronchiectasis in cases
of extensive pulmonary fibrosis

13. • Common in the left lower lobes
• Upper lobes are affected least frequently
• Middle lobe and lingula occupy an intermediate position
• When left lobe is involved lingula is also expected to be
involved
• Unilateral involvement can also occur

15. • Cough with mucopurulent expectoration(copious amount,
foul smelling)
• Haemoptysis
• Breathlessness
• Fever
• Postural variation of symptoms
• Chest pain

16. • Poor general condition
• Tachypnea
• Dyspnea - Use of accesory muscle of respiration
• Clubbing
• BS – harsh with prolonged expiration
• Coarse leathery crackles
• wheeze

17. • Sputum AFB - 2 samples
• Sputum pyogenic gram stain, culture and
sensitivity(POOR MAN BRONCHOSCOPY)
• Chest X-Ray
• HRCT chest(GOLD STANDARD)
• Bronchoscopy

23. • Local
Haemoptysis
Secondary bacterial infections
Fungal infections
Tuberculosis
Lung abscess
Frequent exaceberations

24. • Systemic
Respiratory failure
Cor pulmonale
Pulmonary artery hypertension(PAH)
Sinusitis
Allergic broncho pulmonary aspergillosis(ABPA)
Aspergilloma
Brain abscess
Secondary amyloidosis

25. • Oral and i.v antibiotics according to sputum culture and
sensitivity
• Bronchodilators
• Mucolytics
• Chest physiotherapy
• Deep breathing exercise

26. • Kartageners syndrome
Situs inversus
Sterility
Sinusitis
• Yong syndrome
Sinusitis
Azoospermia
Bronchiectasis

27. • Brocks syndrome or Middle lobe collapse – bronchus
of the middle lobe are vulnerable to obstruction including
obstruction by enlarged hilar glands ranging from
recurrent middle lobe pneumonia to middle lobe
atelectasis

28. • Definition:
• Chest physiotherapy (CPT) is the treatments
generally performed by Physical therapists and
Respiratory therapists, whereby breathing is
improved by the indirect removal of mucus from the
breathing passages of a patient. -Postural
drainage,
-Chest percussion and vibration,
-Specialized cough techniques known as directed cough.

29. -To move bronchial secretions to the central airways
via gravity,
-External manipulation of the chest, and to eliminate
secretions by cough or aspiration with a catheter.

30. • Preparation :
• 1) Ensure that several hours have passed since the child has
eaten .
• 2.Place the child on a pulse oximeter .
• 3) Place the child in the position to permit gravity drainage of
secretion .
• 4) Administer the bronchodilator , if needed , to relax the
airway muscles .

31. • EQUIPMENT:
• 1) Oxygen mask
• 2 ) Emesis basin or sputum cup .
• 3 ) Pulse oximeter .
• 4 ) Tissues
• 5) Pillows

45. • CONTRA INDICATIONS TO CHEST PT:
• Unstabilized head and/or neck injury
• Active hemorrhage with hemodynamic instability or
significant possibility of occurrence.
• Osteogenesis imperfecta or other bone disease associated
with brittle or extremely fragile bones/ Fracture of ribs
• OTHER CONTRA INDICATIONS:
• Intracranial pressure > 20 mm Hg
• Active hemoptysis
• Acute spinal injury/ Spine surgery
• Pulmonary embolism
• Worsening bronchospasm etc