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Bronchioectasis is an irreversible obstructive lung disease caused by inflammation and infection of the bronchioles. It is caused by congenital conditions, post-infection, or other factors. Symptoms include persistent coughing that is worse at night and with posture changes, purulent sputum, intermittent hemoptysis, fever, and malaise. Signs include coarse crackles, reduced or absent breath sounds, wheeze, and clubbing. The disease results in destruction of alveolar vessel walls and scarring/fibrosis of the parenchyma, dilating airways as surrounding scar tissue contracts. Investigations include sputum culture, chest X-ray, CT scan, spirometry
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- 1. Bronchioectasis Bronchioectasisisanirreversibleobstructive lungdisease causedbyinflammationandinfectionf the bronchioles. It iscaused by Congenital conditions (Cysticfibrosis,primaryciliarydyskinesia,Young'ssyndrome) Post-infection ( TB,HIV,pneumonia,measles,bronchiolitis,pertusis) Other(foreignbody, tumour,ulcerativecolitis,rheumatoidarthritis,idiopathic, hypogammaglobulinamia) Symptoms: coughing(persistentworse atnightandaggravatedbychangesinposture),purulent copioussputum,intermittenthaemoptysis,feverandmalaise. Signs : Bilateral/unilateral coarse crackles,reducedorabsentbreathsounds, wheeze,inspiratory crepitationsand clubbing Pathology: an obstructionresultsin destructionof the alveolarvessel walls andthe elastin containedwithinthem.The destructionisthenfollowedbyscarringandfibrosingof the parenchyma. Airwaysdilateasthe surroundingscartissue contracts. The lowerlunglobes are mostseverelyaffectedleadingto poolingof the bronchial secretions increasingthe riskof furtherinfections. Investigations: Sputumculture (identifybacterial organisms) CXR (normallynormal,inadvanceddisease,youmaysee areasof thickenedairwaywalls, cyst spacesand consolidation andcollapse) HighresolutionCT(signetringappearance) Spirometery (obstructivepattern) Bronchoscopy (identifyobstructionpoint) Serumimmunoglobulin Sweatelectrolytetesting/geneotyping/mucociliaryclearance (excludeorprove CFas a causal factor) Management: 1) Postural chestdrain withchestphysiotherapy(teachpatienttolie downflatinordertohave chest drain3 timesa day)
- 2. 2) Antibiotics 3) Corticosteroids(prednisalone) 4) Bronchodilators(Beta-2agonistse.g.salbutamol) helpful inpatientswithasthmaandCOPD 5) Surgery(rare,indicatedif bronchioectasislocalised) Complications 1) Pneumonia 2) Abscessinlungor cerebral abscess 3) Pneumothorax 4) Haemoptysis 5) Amylodosis 6) Cor Pulmonale 7) Empyema 8) Pleural effusion 9) Pulmonaryfibrosis NB> primaryciliarydyskinesiacanpresentwithmisscariagesdue tofemale beingunableto transportfertilisedeggthroughfallopiantubestothe uterus.Thisis due tothe ciliabeingdamaged and notfunctioningcorrectlyinprimaryciliarydyskinesia.