Detail about bromchiectasis

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