Bronchiectasis is a chronic lung condition characterized by abnormal dilatation of the bronchi. It occurs due to destruction of the elastic and muscular components of the bronchial wall from repeated pulmonary infections. Common causes include cystic fibrosis, pneumonia, tuberculosis, and allergic bronchopulmonary aspergillosis. Symptoms include chronic cough with purulent sputum, pneumonia, hemoptysis, and poor health. Diagnosis involves sputum culture, chest x-ray, and high-resolution CT scan of the chest. Management includes chest physiotherapy, antibiotics, and sometimes surgery for uncontrolled infections or hemorrhage. Complications can include recurrent lung infections, abscesses, and respiratory failure.

1. BRONCHIECTASIS
Dr. Aswini Kumar
Mohapatra
Professor & Head
Dept. of Pulmonary Medicine

2. Definition :
 Characterized by chronic permanent and
abnormal dilatation of bronchi, which
contain cartilage and bronchial glands. It
occurs due to destruction of the elastic and
muscular components of the bronchial wall
 Chronic mucopurulent expectoration and
recurrent acute pulmonary infections

3. Causes of Bronchiectasis :
I. Congenital :
- Cystic fibrosis
- Ciliary dysfunction syndromes
Primary ciliary dyskinesis Kartagener’s
syndrome
(Immotile cilia syndrome) (Sinusitis and
transposition of
the
viscera)
- Primary hypogammaglobulinemia

4. II. Acquired:
A. Children -
 Pneumonia (complicating whooping cough and
measles)
 Primary TB
 Inhaled foreign body
B. Adults -
 Suppurative pneumonia
 Pulmonary TB
 Allergic bronchopulmonary aspergillosis
 Bronchial tumours

5. Pathogenesis :
 Infection and obstruction-two important
key features
 Repeated pulmonary infections coupled with
defective host defenses with impaired
clearing mechanism
 Mechanical obstruction or obstruction due to
muscus impaction impairs clearance leading
to repeated infection

6.  Vicious cycle of infection  Obstruction
infection goes on.
 Microorganisms attract neutrophils to the sites of
inflammation
 Neutrophils Proteolytic enzymes

Neutrophil elastase
Epithelial damage Bronchial gland hyperplasia
Connective tissue
damage
Bronchial distortion

7. Types:
1. Cylindrical or fusiform
2. Varicose
3. Cystic or saccular
4. Follicular

8. Symptoms:
 Cough: Chronic productive with purulent
expectoration Halitosis ±
 Pneumonia and pleurisy-Due to inflammatory
changes in the airways. Fever, malaise and
increased cough and sputum volume. Chest pain
and recurrent pleurisy in the same site
 Haemoptysis
 Poor personal health
 Extensive disease+ purulent sputum anorexia,
weight loss, lassitude , low grade fever and
failure thrive in children

9. Signs:
 May be unilateral or bilateral
 No secretions in the bronchiectatic airways  no
abnormal physical signs
 Large amount of secretions in the airways  Coarse
crackles
 Collapse with retained secretions blocking proximal
bronchus. Diminished breath sounds
 Advanced Disease  Dilatation of the bronchi 
bronchial breathing clubbing

10. Investigations:
1. Bacteriological and mycological examination of the
sputum
2. Radiological examinations -
A. Plain chest x-ray-
 ‘ring shadows’ or ‘honey coombing’ due to cystic
dilated bronchi
 ‘tramline shadows’ or ‘band shadows’

11. B.Bronchography :
 Most accurate diagnostic procedure for evaluating
Bronchiectasis, particularly when contemplating
surgery.
 Contrast used- Dianosil
 Main indication is to find out whether apparently
looking dilations show any evidence of
Bronchiectasis, so that surgery can be or can not
be undertaken
 replaced by CT-scan

12. C. HRCT thorax :
 Use of 1.0 to 1.5mm window every 1cm with
acquisition times of one second
 Most sensitive and specific test for diagnosing
Bronchiectasis

13. 3. Assessment of ciliary function:
 Pellets of saccharin placed in the anterior chamber of
the nose to reach the pharynx, when patient can taste
it. This time greatly prolonged in patients with ciliary
dysfunction
 Structural abnormality of the Cilia  detected by
election microscopy

14. Management :
1.Chest physiotherapy/broncho-pulmonary
hygiene -
 Helps in the drainage of excessive bronchial
secretions
 Patient should adopt a position in which the
lobe to be drained is uppermost
 Deep breathing followed by forced expiratory
man oeuvres helps in moving secretions in the
dilated bronchi towards the trachea, from which
they can be cleared by vigorous coughing
 Percussion of the chest wall with cupped hands

15.  Devices-
o Positive expiratory pressure masks
o flutter valve aid sputum clearance
 Duration -
 Optimum duration and frequency of physiotherapy
depend on the amount of sputum. 5-10
minutes/once or twice daily
 Maintaining adequate systemic hydration

16. 2. Antibiotics
Depend on the organisms isolated from the sputum.
Most common bacteria:-
 H. influenzae
 P. aeruginosa
 S. aureus
- Penicillin or ampicillin + aminoglycocide covers
H.influenzae and S,.aureus
- For pseudomonas –antibiotic therapy more
challenging

I.V ceftazidime (1-2gm/8hrly)
Or Oral Ciprofloxain 250-750mg / 12hrly

17. 3. Surgery
Role of surgery for Bronchiectasis has declined
but not disappeared
Indications -
a) Failure of medical therapy with repeatd
exacerbations
b) Uncontrolled haemoptysis
c) Obstructive lesions i.e. tumour
surgery it contemplated , in whom the Bronchiectasis is
unilateral and confined to a single lobe or segment on CT
 main stay of surgery resection of destroyed
areas of lung which are acting as a reservoir of
infection

18. Complications:
 Local Systemic
Local :
 recurrent pneumonia
 Lung abscess
 Empyema
 Haemoptysis
 Pulmonary artery hypertension with Cor-pulmonale
 Congestive cardiac failure and
 Respiratory failure
Systemic :
 Hypoproteinemia- generalised edema
 Amyloidosis-nephrotic syndrome due to secondary amyloidosis