Bronchiectasis is a chronic lung condition characterized by abnormal, permanent dilation of the bronchi and bronchioles. It is most commonly caused by recurrent lung infections that destroy the airways over time. The main symptoms include a persistent cough with sputum production, respiratory infections, hemoptysis, dyspnea, and nail clubbing in severe cases. Diagnosis is made through chest imaging such as high-resolution CT scan that shows the dilated airways. Treatment involves controlling infections with antibiotics, clearing secretions through chest physiotherapy, treating any underlying causes, and surgery in rare cases of localized disease. Complications can include recurrent pneumonia, lung abscesses, and respiratory failure in advanced cases.
COPD is a chronic respiratory illness that is associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Severe COPD can lead to respiratory failure, repeated hospitalization and death. One of the most important risk factors for COPD is tobacco smoking.
This presentation is about Emphysema and Chronic Bronchitis made by CHAKRAPANI BHUVANESH.
Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic.
COPD is a chronic respiratory illness that is associated with an abnormal inflammatory response of the lungs to noxious particles and gases. Severe COPD can lead to respiratory failure, repeated hospitalization and death. One of the most important risk factors for COPD is tobacco smoking.
This presentation is about Emphysema and Chronic Bronchitis made by CHAKRAPANI BHUVANESH.
Bronchitis is an inflammation of the lining of your bronchial tubes, which carry air to and from your lungs. People who have bronchitis often cough up thickened mucus, which can be discolored. Bronchitis may be either acute or chronic.
What is emphysema?
Emphysema is a condition that forms part of chronic obstructive pulmonary disease (COPD) and involves the enlargement of the air sacs in the lung.
The alveoli at the end of the bronchioles of the lung become enlarged because of the breakdown of their walls. The fewer and larger damaged sacs that result mean there is a reduced surface area for the exchange of oxygen into the blood and carbon dioxide out of it.
Definition
Emphysema is a condition in which the alveoli become stiff expands and continuously filled the air even after expiration. Emphysema is a chronic obstructive disease due to lack of elasticity in the lungs and alveoli surface area.
Classification
Panlobular (panacinar)
It is damage to the respiratory bronchi, alveolar ducts and alveoli. All air space in the little lobes much enlarged, with little inflammatory disease. The characteristics that have chest hyperinflation, and is characterized by dyspnea on exertion, and weight loss.
CENTRILOBULAR (CENTROACINAR)
The pathological changes mainly occur in the centre of the secondary lobes, and peripheral of acini remain good. Often there is chaos-ventilation perfusion ratio, which lead to hypoxia, hypercapnia (increased CO2 in the arterial blood), polycythaemia and heart failure episodes right. The condition leads to cyanosis, peripheral oedema, and respiratory failure.
CAUSES OF EMPHYSEMA
The biggest known cause or risk factor for emphysema - and for COPD - is smoking. Cigarette smoking is responsible for around 90% of cases of COPD. However, COPD will develop only in smokers who are genetically susceptible - smoking does not always lead to the disease.
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Pneumoconiosis- dust with size and different types of occupational pneumoconic diseases, clinical features, diagnosis and prevention of pneumoconiosis.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
What is emphysema?
Emphysema is a condition that forms part of chronic obstructive pulmonary disease (COPD) and involves the enlargement of the air sacs in the lung.
The alveoli at the end of the bronchioles of the lung become enlarged because of the breakdown of their walls. The fewer and larger damaged sacs that result mean there is a reduced surface area for the exchange of oxygen into the blood and carbon dioxide out of it.
Definition
Emphysema is a condition in which the alveoli become stiff expands and continuously filled the air even after expiration. Emphysema is a chronic obstructive disease due to lack of elasticity in the lungs and alveoli surface area.
Classification
Panlobular (panacinar)
It is damage to the respiratory bronchi, alveolar ducts and alveoli. All air space in the little lobes much enlarged, with little inflammatory disease. The characteristics that have chest hyperinflation, and is characterized by dyspnea on exertion, and weight loss.
CENTRILOBULAR (CENTROACINAR)
The pathological changes mainly occur in the centre of the secondary lobes, and peripheral of acini remain good. Often there is chaos-ventilation perfusion ratio, which lead to hypoxia, hypercapnia (increased CO2 in the arterial blood), polycythaemia and heart failure episodes right. The condition leads to cyanosis, peripheral oedema, and respiratory failure.
CAUSES OF EMPHYSEMA
The biggest known cause or risk factor for emphysema - and for COPD - is smoking. Cigarette smoking is responsible for around 90% of cases of COPD. However, COPD will develop only in smokers who are genetically susceptible - smoking does not always lead to the disease.
BRONCHIAL ASTHMA
ntroduction
Definition
Etiological factors
Pathophysiology
Types of asthma
Clinical manifestation Restlessness Wheezing or crackles Absent or diminished lung sounds Hyper resonance Use of accessory muscles for breathing Tachypnea with hyperventilation
Clinical manifestation
Diagnostic evaluation
Bronchoprovocation Testing: Testing that is done to identify inhaled allergens; mucous membranes are directly exposed to suspected allergen in increasing amounts. Skin Testing: Done to identify specific allergens. Exercise Challenges: Exercise is used to identify the occurrence of exercise-induced bronchospasm. Radio allergosorbent Test: Blood test used to identify a specific allergen. Chest Radiograph: May show hyper expansion of the airways.
Managemnet
Goal- Promote bronchodilationn Reduce inflammation Remove secretions Prevent ongoing symptoms Prevent asthma attack Maintain normal lung function Avoid triggers
Pharmacological therapy 1. Long term control medication- Inhaled corticosteroid Leukotriene modifiers Long acting beta agonist Methylxanthines Combine inhaler
2 Quick relief medication Short acting beta agonist Anticholinergic Oral or I/V corticosteroid
3 Bronchial thermoplasty- Form severe asthma that does not respond to medication
Non- pharmacological
Oxygen therapy Postural drainage & chest physiotherapy Coughing & deep breathing exercise Avoidance of allergen relaxation technique acupuncture
Prevention
Patients with recurrent asthma should undergo tests to identify the substances that precipitate the symptoms. Possible causes are dust, dust mites, roaches, certain types of cloth, pets, horses, detergents, soaps, certain foods, molds, and pol- lens. If the attacks are seasonal, pollens can be strongly sus- pected. Patients are instructed to avoid the causative agents whenever possible.
Complications Complications of asthma may include status asthmaticus, respiratory failure, pneumonia, and atelectasis. Airway obstruction, particularly during acute asthmatic episodes, often results in hypoxemia, requiring the administration of oxygen and the monitoring of pulse oximetry and arterial blood gases. Fluids are administered, because people with asthma are frequently dehydrated from diaphoresis and in- sensible fluid loss with hyperventilation.
Nursing diagnosis
Impaired gas exchange r/t altered oxygen supply Ineffective airway clearance r/t bronchospasm & obstruction from narrow lumen Ineffective breathing pattern r/t bronchospasm Risk for increasing attack of r
espiratory distress r/t exposure to allergens
Bronchial Asthma - Epidemiology, Pathogenesis and ManagementShashikiran Umakanth
Bronchial asthma is a chronic disease with airway inflammation as a central theme in its pathogenesis. Prevalence of this condition is gradually increasing, especially in developed countries and in countries that are getting "westernized". With early diagnosis, regular monitoring and prompt and rational treatment, most patients with asthma can lead a symptom-free life.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
At the end of this lecture student able to:
Define COPD
List causes of COPD
List risk factors of COPD
List signs and symptoms of COPD
List diagnostic measures
Describe treatment of COPD
Identify complications of COPD
Use nursing process
Discuss relevant patient / family education
Pneumoconiosis- dust with size and different types of occupational pneumoconic diseases, clinical features, diagnosis and prevention of pneumoconiosis.
These lecture notes were prepared by Dr. Hamdi Turkey- Pulmonologist- Department of internal medicine - Taiz university
Do Not Forget To Visit Our Pages On Facebook on the following Links:
https://www.facebook.com/groups/569435236444761/
AND
https://www.facebook.com/groups/690331650977113/
PNEUMONIA,
DEFINITION
Pneumonia is an infection of the pulmonary parenchyma.
To the pathologist, pneumonia is an infection of the alveoli ,distal airways, and interstitium of the lung that is manifested by increased weight of the lungs, replacement of normal lung’s sponginess by consolidation ,and alveoli filled with white blood cells ,red blood cells and fibrin .To the clinician, pneumonia is a constellation of symptoms and signs in combination with at least one opacity on CXR.
Epidemiology
Between 5 and 10 million cases of infectious pneumonia occur annually in the United States and result in more than 1 million hospitalizations.
Pneumonia is a leading cause of death worldwide, the sixth leading cause of death in the United States, and the most common lethal infectious disease.
to differentiate b/w wheezing and stridor....lead to know to make clinical dx for asthma, croup, laryngomalacia, epiglottis...there many noisy breathing....our focus wheezing n stridor....
Community Acquired Pneumonia and other types of pneumonia
for medical students
Detailed information on pneumonia including the following
Definition
Classification
Aetiology
Pathogenesis
Pathological states
Investigations
Treatment & follow up
Complications
Medication
Hospital acquired pneumonia and it’s treatment and management and prevention
Other types of pneumonia
And pneumonia in immune compromised patients
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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2. Abnormal permanent dilatation of bronchior sub
segmental bronchi with inflammatory destruction of
peribronchial tissue [muscle, cartilage] with accumulation of
secretions in the dependent bronchi
Bronchiectasis is a chronic, irreversible dilation of the
bronchi and bronchioles. Under the new definition of COPD,
it is considered a separate disease process from COPD
(NIH, 2001).
BRONCHIECTASIS – DEFINITION
It is common in
age group of 5‐15
Years
Types
Congenital
/ Hereditary
Acquired
3. CAUSES / ETIOLOGY
•Airway obstruction
•Diffuse airway injury
•Recurrent Pulmonary infections
•Obstruction of the bronchus or complications of long-term
pulmonary infections
•Genetic disorders such as cystic fibrosis, Ciliary abnormalities
‐ Kartageners syndrome, Immotile cilia syndrome, yellow nail
syndrome, alpha 1 anti‐trypsin deficiency
•Abnormal host defense (eg, ciliary dyskinesia or humoral
immunodeficiency)
•Aspiration
•Childhood infections – measles, pertussis
•Idiopathic causes
4. ACQUIRED CAUSES
5
Infection Obstruction Aspiration
syndrome
Near drowning
Oropharyngeal
surgery
General anesthesia
Dental extraction
GERD
Hydrocarbon
poisoning
BACTERIAL
Tb ,Pertussis,
Mycoplasma
VIRAL
Measles, Viral
Pneumonia, HIV
Chronic lung allograft
rejection
Foreign body
Lymph nodes
Cardiomegaly
Tumors
Endobronchial TB
Inspissated mucus‐
[cystic fibrosis,
Immotile cilia
syndrome]
5. TYPES
Classic ‘Reid’ classification (gross histological
appearance) ‐ three different patterns
1. Cylindrical bronchiectasis ‐ mildly uniform
airway dilation
2.Varicose bronchiectasis ‐ focally dilated areas
between narrowed segments
3.Saccular bronchiectasis ‐ balloon‐like airway
dilation with more disruption of lung parenchyma
6
6. TYPES - Bronchiectasis
Figure 14–1. Bronchiectasis. A, Varicose bronchiectasis. B, Cylindrical bronchiectasis. C,
Saccular bronchiectasis. Also illustrated are excessive bronchial secretions (D) and
atelectasis (E), which are both common anatomic alterations of the lungs in this disease.
D
E
A
B
C
7. PATHOGENESIS
8
• Chronic infection – recruitment of neutrophils,
T‐lymphocytes, monocyte‐derived cytokines with
release of inflammatory mediators ‐ elastases &
collagenases
• Loss of ciliated columnar epithelium
• Micro‐abscess in bronchial wall with
peribronchial inflammation
• Destruction ‐ elastic & muscle tissue, cartilage of
bronchus.
• Endarteritis of pulmonary vessels
• Bronchial arterial proliferation (predisposes to
hemoptysis)
8.
9. CLINICAL MANIFESTATIONS
10
• Most common symptom ‐ persistent cough, typically
"wet" or productive
• Episodic exacerbations of infection‐
• Increased cough and sputum production
• Fever
• Pleuritic chest pain
• Dyspnea
• Absence of sputum production does not exclude
bronchiectasis (younger children may not be able to
expectorate)
Contd..
10. • Hemoptysis ‐ uncommon in children
• Occurs ‐ erosion of inflamed airway tissue adjacent to
pulmonary vessels.
• Bleeding
• Mild, with blood streaked sputum
• Profuse amounts of fresh bleeding if larger
pulmonary vessels rupture.
• Dyspnea and exercise intolerance
• Uncommon at presentation
• May develop as disease progresses
• May occur during acute exacerbation (intercurrent
infection)
Contd
11
CLINICAL MANIFESTATIONS
11. • Cyanosis‐ severe bronchiectatic lung disease
• Severe hypoxemia due to mismatched pulmonary
ventilation and perfusion.
• Nail clubbing
• If hypoxemia ‐ prolonged and profound‐ cause
pulmonary hypertension & cor‐pulmonale.
12
CLINICAL MANIFESTATIONS
12. PHYSICAL EXAMINATION
13
1. General physical examination
2. Symptoms of cough – copious amount; pus +/- &
Haemoptysis
3. Sinus and ear infections
4. Presence of congenital anomalies
5. Signs - Clubbing
1. Schamroth sign‐ obliteration of the quadrangular
space when both fingers kept in unison
2. Distal phalangeal depth (DPD) to interphalangeal
depth ratio (IPD) > 1
6. Coarse leathery crackle over areas of bronchiectasis
14. DIAGNOSIS
• Diagnosis depends on radiographically or anatomically visualizing
abnormal dilatation of airways
• Diagnostic procedure of choice ‐ High‐Resolution Computed
Tomography (HRCT) scan
• Other tests‐ diagnose underlying conditions.
• Contd..
15
15. LABORATORY
INVESTIGATIONS
16
Complete blood count with differential
Sputum exam‐ volume, gram stain, C & S ,
Immunodeficiency‐ Total IgM, IgA and IgG
Tests for Tuberculosis –
• Mantoux
• Chest X‐ray
• Resting Gastric juice for AFB
Test for cystic fibrosis (sweat chloride and/or DNA
testing)
HIV screening
16. INVESTIGATIONS
Flexible bronchoscopy
• shows structural alteration of bronchial tree
• bronchoalveolar lavage ‐ remove mucus plugs/ to obtain
lower airway cultures.
• If an airway foreign body is discovered‐rigid
bronchoscopy ‐for removal
Ciliary biopsy
• Test for GERD : 24 hour pH monitoring, upper
gastrointestinal endoscopy and technetium milk scan
scintigraphy.
• Test for aspiration due to inadequate airway protective
mechanisms during swallowing or dysphagia
‐evaluated by video fluoroscopy
17
17. INVESTIGATIONS
• Pulmonary function tests ‐severity of lung disease
• should be performed if the patient is able to do
• useful tool to evaluate long‐term progression of lung
disease.
• Most patients with bronchiectasis have features of
obstructive lung disease (low FEV1 & FEV1/FVC ratio)
• Test for allergic bronchopulmonary aspergillosis
• Immunoglobulin E (IgE)
• Serum precipitins for Aspergillus species
• Sputum culture for fungus
• Aspergillus skin test
18
18. CHEST RADIOGRAPHY
• Dilated and thickened airways (tram‐tracking or parallel lines)
• Irregular peripheral opacities that represent
mucopurulent plugs
• Loss of lung volume and peribronchial fibrosis
Cystic fibrosis ‐ upper lobes
Allergic bronchopulmonary aspergillosis ‐ Centrally located
bronchiectasis
Bronchopulmonary sequestration ‐ lower lobe and usually
unilateral
19
19. IMAGING ‐ CT
• Most sensitive ‐to detect bronchiectasis ‐
high resolution computed tomography (HRCT)
• Internal diameter of airway ‐ larger than
diameter of adjacent artery
• Airway wall thickening ("signet ring" shadows)
with or without air fluid levels
• Volume loss, mucus plugging and air trapping
20
21. MEDICAL MANAGEMENT
22
• Immediate
– Medical treatment
– Postural drainage
– Relief of atelectasis
– Treatment of associated problems
• Long term
– Continuation of postural drainage
22. Treatment –any identified underlying disorder Therapy
• reduce airway secretions
• facilitating their removal ‐ with chest physiotherapy &
mucolytic agents
Pharmacotherapy
• to improve mucociliary clearance. Antibiotics
• prevent & treat recurrent infections
• Surgery‐ if localized disease ‐may be considered.
MEDICAL MANAGEMENT
23. CHEST PHYSIOTHERAPY
• Facilitate mucous expectoration ‐ manual and
mechanical interventions
• Chest percussion
• Vibration
• Postural drainage
• Cough‐assist devices & airway oscillation‐serve as
adjuncts to cough (most effective and efficient
manner of clearing airway) .
24
24. SURGICAL TREATMENT
Only in unilateral disease
Removal of affected segment/ lobe/lung
Surgery contraindicated if bilateral disease
Unilateral ‐ surgical resection ‐ good prognosis
25
26. PREVENTION OF BRONCHIECTASIS
• Childhood immunization for measles and pertussis
• Screening for tuberculosis and treatment wherever needed
• Aggressive appropriate therapy of lower respiratory tract infections
• Therapy of child with chronic or recurrent respiratory problems
due to recurrent aspiration and/or gastroesophageal reflux
disease
27
27. PROGNOSIS
• Overall ‐ prognosis – good
• Progressive bronchiectasis from underlying disease
or ongoing pulmonary insult –causes progressive
obstructive defect & ultimately, respiratory
compromise
28
28. Nursing Management
• Alleviating symptoms and assisting the patient to clear
pulmonary secretions.
• Health education – Cessation of Smoking and removal other
factors that increase the production of mucus. The patient and
family are taught to perform postural drainage and to avoid
exposure to others with upper respiratory and other infections.
• If the patient experiences fatigue and dyspnea, strategies to
conserve energy while maintaining as active a lifestyle as
possible.
• The patient needs to become knowledgeable about early signs
of respiratory infection and the progression of the disorder so
that appropriate treatment can be implemented promptly.
• Because the presence of a large amount of mucus may
decrease the patient’s appetite and result in an inadequate
dietary intake, the patient’s nutritional status is assessed, and
strategies are implemented to ensure an adequate diet.