Bronchiectasis is an obstructive lung disease characterized by irreversible dilation and destruction of bronchial walls, primarily caused by chronic inflammation and infections. It can be classified into cylindrical, varicose, and saccular forms, with common causes including congenital conditions like cystic fibrosis and acquired conditions such as tuberculosis. Diagnosis involves a combination of patient history, sputum analysis, radiological examinations, and pulmonary function tests, while management may include antibiotics and surgery.

1. BRONCHIECTASIS An
Obstructive Lung Disease
Presented By :
Dr. Maryum Malik - Resident Medicine ( R1 )
Sahiwal Teaching Hospital , Sahiwal

2. Lung Diseases
OBSTRUCTIVE
i-e. we can not get the air
out
• Bronchial Asthma
• Chronic Bronchitis
• Emphysema
• Bronchiectasis
• Bronchiolitis
RESTRICTIVE
i-e. we can not get the air
in
• ILD
• Sarcoidosis
• Scoliosis
• Obesity
• Neuromuscular Disease

3. Definition :
Disorder of the large bronchi characterized by
irreversible/permanent abnormal dilation & destruction of
bronchial walls.

5. Pathophysiology Of
Bronchiectasis :
• Microorganisms trigger inflammatory
response i-e. release of Neutrophils,
Lymphocytes/Macrophages
• Neutrophils alters function of ciliary
epithelium that changes the cilial beat
frequency & mucous gland hypersecretion
• Impaired muco ciliary clearance & Airway
mucous hypersecretion leads to microbial
colonization/infection
• Neutrophils releases inf. cytokines +
elastases & matrix metalloprotienases that
destroy bronchial elastin & other supporting
lung structures
• In response to this a cycle of intense Chronic
Inflammation occurs resulting in BRONCHIAL
DILATION & DESTRUCTION.
its pathophysiology is
commonly described as
distinct phases of
infection and chronic
inflammation. The
interaction between
these phases establishes
a vicious circle.

8. Classification Of Bronchiectasis On
The Basis Of Morphology :
1. Cylindrical bronchiectasis: bronchi are enlarged and cylindrical.
2. Varicose bronchiectasis: bronchi are irregular with areas of
dilatation and constriction.
3. Saccular or cystic: dilated bronchi form clusters of cysts. This is
the most severe form of bronchiectasis and is often found in patients
with cystic fibrosis

10. Aetioloy ( Causes ) Of
Bronchiectasis :
1. CONGENITAL :
• Cystic Fibrosis ( Most Common Cause In US & All Western
Countries ! ) : CFTR gene defect > Defective Ion Transport > Airway
Surface Liquid Depletion > Impaired Muco ciliary Clearance
• Ciliary Dysfunction Syndromes : Absent dynein arm in cilia
* Primary Ciliary Dyskinesia - Immotile Cilia Syndrome
* Kartagener's Syndrome - Triad Of Situs Inversus , Chronic
Sinusitis & Bronchiectasis
• Alpha-1 antitrypsin (AAT) deficiency : Disruption of Protease
- Anti protease balance > Neutrophils Elastases & Proteases
destroy lung structure
• Primary Hypogammaglobulinemia

11. 2. ACQUIRED :
A. CHILDREN -
• Primary Tuberculosis ( Most Common Cause World Wide + 3rd World
Countries i-e, Egypt / Developing Countries )
• Severe Infections In Infancy : Whooping Cough/Pertussis , Measles
• Inhaled Foreign Body
B. ADULTS -
• Pulmonary Tuberculosis ( Most Common Cause World Wide + 3rd
World Countries i-e, Egypt / Developing Countries )
• Suppurative Pneumonia
• Mycobacterium Avium Complex MAC : Non Tuberculous
Mycobacterium
• Allergic Bronchopulmonary Aspergillosis ABPA

12. Kartagener's Syndrome Visual Map

13. CLINICAL FINDINGS :
A. SYMPTOMS -
• Chronic Cough + Production Of Copious Amounts Of Purulent
Sputum i-e. Foul smelling sputum ( Classic Symptom! )
• Hemoptysis - resulting from airway damage
• Pleuritic Chest Pain - d/t inflammatory changes in the airways
• Dyspnea , Weight Loss , Anemia & Other Systemic Manifestations
are common.
B. SIGNS -
• Coarse Crackles at the Lung Bases
• Wheezing
• Clubbing - More frequent in Moderate to Severe Cases

14. DIAGNOSIS :
1. History + Physical Examination - Compatible History Of Chronic
Respiratory Symptoms i-e. Daily Cough & Purulent Sputum Production
2. Sputum Analysis - Bacteriological & Mycological Ex. Of Sputum
3. Radiological Examinations
a. Plain Chest X-ray -
Tram-track opacities i-e. dilated bronchi with thickened walls (tram-
track sign) or as ring-like markings. Scattered Irregular Opacities ,
Atelectasis & Focal consolidation may be present. Overall there appears
to be an increase in bronchovascular markings.
b. HRCT Chest ( Most Sensitive & Specific Test For Diagnosing
Bronchiectasis ) -
• Tram-Track Appearance : Lack of narrowing in the caliber of bronchus
towards periphery i-e. dilated bronchi with thickened walls
• Signet Ring Sign : Bronchus & Pul. Artery should be of same size but in
BE Bronchus is markedly dilated than Pul. Artery

15. 4. Pulmonary Function Tests PFTs - Obstructive Pattern i-e. Low
FEV1/FVC ( Normal : 0.75 - 0.85 )
5. Tests To Identify Underlying Illness -

16. 6. Assessment Of Ciliary Function -
Electron microscopy
Healthcare provider can use a special microscope, called an electron
microscope, to look at samples of airway cilia. This test can show
whether there are any problems with the structure of your cilia or how
they are working.

20. MANAGEMENT :

23. 2. Antibiotics :

27. 3. Surgery :

29. COMPLICATIONS OF BRONCHIECTASIS :
1. Hemoptysis
2. Cor Pulmonale
3. Amyloidosis
4. Secondary Visceral Abscesses At Distant Sites i-e. BRAIN