Understanding the bronchiectasis prognosis


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Understanding the Bronchiectasis Prognosis Now! Here!
The article below will discuss the bronchiectasis prognosis of in a complete and detailed.

Before you find out about the bronchiectasis prognosis, would be better if you also have to know some things about bronchiectasis such as epidemiology, definition, and fatofisiologi Pathogenesis, pathology, etiology and predisposing factors, clinical features, clinical manifestations, physical examination, diagnosis and treatment of bronchiectasis.

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Understanding the bronchiectasis prognosis

  1. 1. Understanding the Bronchiectasis PrognosisUnderstanding the Bronchiectasis Prognosis Now! Here!The article below will discuss the bronchiectasis prognosis of in a complete and detailed.Before you find out about the bronchiectasis prognosis, would be better if you also have to know somethings about bronchiectasis such as epidemiology, definition, and fatofisiologi Pathogenesis, pathology,etiology and predisposing factors, clinical features, clinical manifestations, physical examination,diagnosis and treatment of bronchiectasis .Epidemiology of bronchiectasisBefore you know about bronchiectasis prognosis then the first thing you need to know the epidemiologybronchiectasis. Worldwide incidence of bronchiectasis is still high, usually occurring in underdevelopedcountries or developing countries. In the era before antibiotics the symptoms usually appear in the firstdecade of life. Currently moving towards the onset of adulthood. With limited data, some studiesestimate that between 60-80 years of age is the age most affected by the frequency of bronchiectasisdisease.Definition of bronchiectasisThe next thing you should know before bronchiectasis prognosis is the definition of bronchiectasisbronchiectasis. Bronchiectasis was first introduced by Laenec in 1819. Bronchiectasis is a chronicrespiratory disease (the bronchi and the tree/bronchioles) with characteristics of a permanent abnormaldilatation accompanied by damage to the bronchial wall. Usually found in the area varied changesincluding trans mural inflammation, mucosal edema (cylindrical bronchiectasis), ulceration (cysticbronchiectasis) with neovascularization and the incidence of recurrent obstructs due to infection(bronchiectasis varicose) resulting in changes in bronchial wall architecture and function. Circumstanceswhich often induce the occurrence of bronchiectasis are infection, failure drainage secretions, andairway obstruction or interference with the individual’s defense mechanisms.Etiology bronchiectasisExact cause of bronchiectasis is not known, but many factors which may result in bronchiectasis, bothhereditary factors and acquired factors and it is important for bronchiectasis prognosis.I. Congenital FactorThis rationale first put forward by Grawitz 1880, later followed by Sourbruch. Sourbruch suggests that8% of cases of bronchiectasis are a congenital abnormality. Wayne and Taussing reported 2 cases ofbronchiectasis as a result of congenital abnormalities in both cases the type of bronchiectasis wassaccular type appealable. On examination bronkografi. Bronchial collapse seemed at the time ofexpiration and inspiration at the time of the occurrence of dilatation. This description Underclassmansigns of bronchial cartilage deficiency.www.bronchiectasisprognosis.com
  2. 2. Other bronchiectasis congenital abnormalities are associated with Kartagener syndrome. It is said in theliterature only 20% of patients with dextrocardia suffer from bronchiectasis. Olen therefore of opinionon Congenital bronchiectasis is still controversial, whether it occurs congenital bronchiectasis or occurafter birth but that symptoms are shown at an early age is very little life and symptoms of bronchiectasiswas evident after the patient has an infection such as pertussis, influenza and morbili. Otherabnormalities associated with congenital factor are sequestering lung, pulmonary cystic fibrosis,hypogammaglobulinemia and peripheral nerve disorders bronchial wall.Factor of obstruction and infectionObstruction and infection factors play an important role in the occurrence of bronchiectasis.a) Obstruction:Obstruction can occur at most of the small bronchi branch or on one branch of a large bronchus.Bronchial obstruction in the small branches can be caused by aspiration of mucus into the bronchiallumen, which causes the collapse in the distal part of the obstruction. This situation will causeobstruction of the proximal intraluminal pressure will increase, thus resulting in dilatation of the bronchiin case of infection in the bronchial dilatation as well as destruction of the bronchial wall occurs, therewill be a permanent dilatation of bronchi This situation usually occurs in children who suffer. Pneumoniaand bronchopneumonia who received inadequate treatment.Bronchial obstruction in a large branch incausing collapse of the distal obstruction.If there is infection and destruction of bronchial wall collapsein the bronchi that will happen permanent dilatation of bronchi. Obstruction factors are factors thatcontribute to the occurrence of persistent infection in a state of obstruction, drainage of secretions inthe distal part of the state suffers when this happens continuously will cause bronchial dilatation anddestruction.b) Factors of infection:Acute respiratory tract infections such as bronchopneumonia peribronkial can cause tissue destruction.Peribronkial tissue damage will cause the withdrawal of the bronchial wall causing dilatation of thebronchi.Pathogenesis bronchiectasisIranian classification of bronchiectasis is presented, but is deemed to include broader aspects is theclassification of Reid and it is important for bronchiectasis prognosis. Reid in 1950 divided into 3 types ofbronchiectasis: 1. Silindris - cylindrical bronchiectasiswww.bronchiectasisprognosis.com
  3. 3. 2. Varicose3. Victim or saccularSilindris type is often associated with pulmonary parenchymal damage there is the addition of bronchialdiameter occurs in varicose type bronchiectasis bronchial dilatation is accompanied by a localconstriction in the walls of the tipi bronchus cystic dilatation of progressive dilatation of the bronchiwalked toward the bubble-shaped peripheral dam.Bronchiectasis often occurs after a lung infection caused by viruses, mycoplasma and tuberculosis allprocesses related to inflammation and tissue damage to ¬, also on other conditions that causepulmonary inflammation without his ¬ infection, such as ammonia inhalation, gastro esophageal refluxand pulmonary hypnosis can cause bronchiectasis . Failure of lung defense mechanisms causes chroniclung damage.Mukocilier clearance is a mechanism that most efficient in removing respirable particles includingbacteria, aided by local immunoglobulin, especially IgA and phagocytes, especially macrophages.Sometimes mechanical ¬ me this is not strong enough to carry out their duties eg if inhaled bacteria arequite a lot.At this time experiencing pulmonary inflammatory processes and plasma proteins includingimmunoglobulin and complement enter into the tissues and secretions. Besides circulating phagocytes(neutrophils monocytes dean gathered to enhance phagocytosis of bacteria. There is also a disorder thatcauses lung defense mechanisms persistent bacterial infections such as the immotile cilia,granulomatous hipogammaglobulinernia and chronic disease. Semarang is now known that proteolysisenzymes released by phagocytes that gather and direct cause tissue damage that finally happenedbronchiectasis. This enzyme is derived from the neutrophil elastase (NE).The role of NE in the pathogenesis of bronchiectasis is evidenced by the occurrence of bronchiectasis inpatients with alpha 1 antitrypsin deficiency. This protein is the most powerful natural inhibitor to NE andin the event of deficiency it could lead to the NE that is released from neutrophils remains, active andwww.bronchiectasisprognosis.com
  4. 4. cause tissue damage even though the infection is mild. When found, bronchiectasis is usuallyaccompanied by impaired clearance and will increase the disruption mukocilier other defensemechanisms. Because of that subject would be vulnerable to persistent and recurrent infections andpotentially to further lung damage due to accumulation of phagocytes. These two components namelythe decrease in clearance and persistent infection will lead to bronchiectasis.Condition associated with bronchiectasis1. Bronchial obstruction:Bronchiectasis pascaobstruction can occur in patients with end bronchial tumors, bronkolitiasis andinflammatory disorders such as tuberculosis and foreign body aspiration. Can also occur in patients withmedial lobe syndrome.2. Infection:Bronchiectasis can be derived from necrotic lung infections untreated Rosenstein et al. first giveattention to bronchiectasis after bronkopulmoner necrosis caused by Klebsiella, Staphylococcal, otheraerobic bacteria and a tuberculosis. Can also by M. nontuberkulosis, Mycoplasma pneumonia, anaerobicpulmonary infections and complications of measles, pertussis influenza and adenovirus type 7. Carson etal .. Found impaired acquisition of cilia in the nasal epithelium of children with viral infections in upperrespiratory tract. Most of the infected adenovirus Para influenza.With electron microscopy visible loss ofepithelial cilia progressively during episodes of infection.3. Inflammation:In bronchiectasis has been reported the occurrence of combustion of ammonia in the airways and afterexpires stomach acid that may occur in bronchopulmonary infection that causes infiltrates on chest X-ray picture. Although it is known that the infection is the most hoops in bronchiectasis but the effects ofacid gastric ulceration also come into play.4. Allergic bronchopulmonaryaspergillosis:Allergic bronchopulmonaryaspergillosis is characterized by bronchospasm, bronchiectasis and secretionsthat contain aspergillums. Pathophysiology involves a hypersensitivity reaction to inhaled antigen in thetracheobronchial branching. Bronchiectasis occurs as a result of blockage of secretions that contain Hipaof aspergillums. The process involves an allergic reaction type I (immediate), type 3 Arthus and therewas an increase. Serum levels of IgG and IgE. Scadding believes that the discovery of the proximalsaccular bronchiectasis in the upper lobe is typical for allergic bronchopulmonaryaspergillosis, but thisdoes not occur in all cases and occurred also in patients with bronchiectasis by other reasons.5. Immune Deficiency:www.bronchiectasisprognosis.com
  5. 5. Bronchiectasis and other chronic diseases as well as frequent relapses sinopulmoner infection usuallyoccurs in patients with congenital or acquired immune deficiency. Abnormal B lymphocytes are oftenassociated with bronchiectasis. Hipogammaglobulinemia congenital or acquired is characterized by adecrease. Or loss of circulating IgG in some patients with bronchiectasis.6. Alpha 1 antitrypsin deficiency:Although this condition is often associated with emphysema, but Laurel and Ericson in 1963 found thealpha I antitrypsin deficiency in two of three patients with bronchiectasis, but pathogen preciselyremains unclear. Alpha I antitrypsin to inhibit ¬ proteolysis enzymes that can crush lung possibility is thatthe protease inhibitory lawyer ¬ protect the lung during infection or other inflammatory conditions andlung parenchyma and the airways become more susceptible to damage if the substance is lacking.7. Primary Cilia dyskinesia:Site total inverses, bronchiectasis and nasal polyps or recurrent sinusitis is often found in Kartagener’ssyndrome.8. Cystic Fibrosis:Cystic Fibrosis is characterized by impaired chloride transport disorder resulting turnover chloride intothe cell. There is accumulation of chloride inside the cells so that cells become dry and secretionsbecome thick and even petrified. These circumstances cause chronic irritation and resulting in recurrentinfections.Clinical Manifestation BronchiectasisNot all patients with bronchiectasis provide complaints and symptoms. Bronchiectasis is known as drybronchiectasis. Which is usually located in the upper lobe? The most common complaint is chronicproductive cough. Morning cough, especially in patients with a lot of sputum, cough will occurthroughout the day. Sputum nature always varies in each case. Sputum sometimes white andsometimes colored yellow in patients with severe infections sputum number could reach 400 500 cc /day. Coughing of blood occurs in 50 70% of cases bronchiectasis. Rupture of bronchial arteries can causea massive coughing up blood. Ulceration of the bronchial wall can cause coughing up blood.www.bronchiectasisprognosis.com
  6. 6. Bronchiectasis patients often complain of recurrent fever. Another common complaint was chest painand shortness of breath.On physical examination abnormalities were found hanging from the area, as well as the degree ofairway obstruction that occur. Clubbing is often found in people with bronchiectasis old. Sometimes notfound physical abnormalities. Lung disorder that is often encountered is wet crackles. Other disordersthat can also be found are clada movement disorders. Abnormalities in cardiac percussion and shiftingboundaries.Radiological bronchiectasisIn plain radiographic bronchiectasis often give a normal picture. Ogilvie get 6 of 68 case series have normal radiology finding. CXR in bronchiectasis provides an illustration:- Bronkovaskuler increases- Atelectasis- Lung collapse- Cystic with or without air fluid levelWhen the plain chest X-ray picture is not clear tomogram examination can be done.Bronkografi more accurate examination to determine the type and extent of the bronchiectasis. According to Simon, although bronkografi seems harmless, should not be done without a specific purpose, such as bronkografi only to determine the diagnosis is clear and visible on plain photo tomogram.The main indications to perform bronkografi:1. for the radiological diagnosis- strengthen the diagnosis of bronchiectasis, when clinical suspicion of bronchiectasis whereas normal chest radiograph and tomogram normal or abnormal but no sufficient characteristics to establish the diagnosis of bronchiectasis- In the case of blood cough cases that cannot be explained by the cause- Strengthen information about the nature of lesions that appear at regular chest X-ray picture and the tomogram.www.bronchiectasisprognosis.com
  7. 7. 2. To know the exact anatomic location, size and segmental distribution of the bronchiectasis. This will be done when considering surgery or postural drainage is more appropriate.Bronkografi should be done if the patient is stable, and already done a good bronchial hygiene and it isimportant for bronchiectasis prognosis. It is important to avoid mistakes in the assessment. A lot ofsecretions or blood in the lumen of the bronchi may provide an incomplete picture of the state of thebronchial wall. In congestive heart failure and in patients with poor lung function hopefully examinationis not done.Other Examination of bronchiectasisSputum: Sputum patients with infections, often times if left in place will form a third layer of the upperlayer of clear serous middle layer and lower layer consisting of turbid pus and cellular debris.Microscopically would seem fibers elastic fibers and fibers of muscle fibers as a result of the destructionof the bronchial wall due to inflammation.For bacteriological examination materials should be taken with aspirations transracial sputum.Performed the outward appearance inspection grams, culture and resistance testing.EXAMINATION OF BLOODBlood tests are sometimes within normal limits. Anemia is caused by the Harmonic course of the disease. Leukocytosis occurs when there is active infection with suppuration.Diagnosis of bronchiectasisDiagnosis is often already be established from the history of recurrent cough, recurring fever, coughingup blood that accompanied the picture with or without cystic air fluid level on regular chest X-ray.Bronkografi examination to determine a definitive diagnosis.MANAGEMENT bronchiectasisManagement of patients with bronchiectasis is very important for bronchiectasis prognosis, basicallyconsists of four things:1. Provision of medicines2. Physiotherapy3. Surgery4. Prevention efforts.www.bronchiectasisprognosis.com
  8. 8. Provision of medicines1. AntibioticAntibiotics are meant to control the infection that occurs and it is important for bronchiectasisprognosis. In patients with ambulatory patients who are given antibiotics in case of changes in thenature of the mucous sputum becomes purulent sputum and increasing the amount of:Antibiotics must be in accordance with the results of resistance testing. In a state of acute exacerbationof a broad-spectrum antibiotics are given Robert and Ingold in their research haveThat amoxicillin 2 g / day gives better results compared with ampicillin 4 g / day.This is because the absorption of amoxicillin into the bronchial secretions better than ampicillin.2. BronchodilatorsBronchodilator drugs may be given medication in patients with bronchiectasis who gives a picture ofchronic bronchitis and airway obstruction and it is important for bronchiectasis prognosis.Bronchodilators are useful to improve the clearance mukocilier, smooth muscle relaxation and reduceedema mucosa. Benefits of bronchodilators in patients with bronchiectasis by using salbutamol beenexamined by Nojrodi et al .. There VEP1 increase of 16% after administration of inhaled salbutamol.3. Mucolytic and expectorantMucolytic drug is a drug that can thin the secretions in the airways by reducing or eliminating thethreads and mukoproteinmucopolysaccharide sputum and it is important for bronchiectasis prognosis.The use of medicinal drugs in patients with bronchiectasis mucolytic particularly useful to say on thestate of a substance that increases the toxicity of substances like peroxide on acrolein toxicity.Expectorant drug is a drug that can stimulate the secretion of phlegm from the airways. Mechanism ofaction is to stimulate expectorant gastric mucosa and subsequent reflexively stimulate the secretion ofthe airways, thereby reducing sputum viscosity and facilitate expenditure. Has become customary to usea cough expectorant every complaint.Until now no data showing an increase in the clearance or repairof a constant condition of the patient after administration of expectorant.According to Cott GR, very fewof the benefits of expectorant.4. Steroidswww.bronchiectasisprognosis.com
  9. 9. Steroids should be considered if found any component of allergic aspergillums bronkopulmonercommoners and also proved effective in bronchiectasis caused by cystic fibrosis and sometimes and it isimportant for bronchiectasis prognosis.5. Other therapiesGamma globulin effective in patients with hipogammaglobulinemia and should be given a lifetime and itis important for bronchiectasis prognosis. The benefits of this therapy in secondaryhipogammaglobulinemia state remain unclear, but may be useful in a failed state with antibiotictherapy.Immune suppression therapy is useful in circumstances of severe infections caused by increasedimmunoglobulin and immune complex.Antacids can be given to people associated with gastrointestinal reflux.Radiotherapy is useful at least in the short term, if the occlusion of tumor is the cause of disease.Treatment of any infection, upper respiratory symptoms sometimes can improve bronchiectasis.PhysiotherapyPhysiotherapy in patients with bronchiectasis meant to remove secretions in the airways and it isimportant for bronchiectasis prognosis. With adequate physiotherapy secretions in the airways will flowout and this can significantly improve lung function.Physiotherapy is done is breathing exercises and postural drainage. Postural drainage is performed ifexcessive sputum production and sputum retention occurred. Postural drainage is not recommended inpatients with impaired pulmonary physiology or patients with severe heart trouble. Postural drainagepositions depending on the location of the affected segment.SURGICALSurgery is performed when conservative treatment is adequate with no complaints remained basicallythe surgery performed on- Recurrent infections- recurrent coughing up blood- massive coughing up bloodwww.bronchiectasisprognosis.com
  10. 10. The operation performed depends on the location, size and lung function can be segmentektomiSurgery patients, lobectomy or pneumonectomy and it is important for bronchiectasis prognosis.Surgery does not guarantee the patient free from bronchiectasis. Ginsberg et al. found 85 of 221 casesoperated on their side of the bronchiectasis.Prevention of bronchiectasisPrevention efforts include the provision of immunization, adequate treatment in patients withpneumonia, bronchopneumonia, pertussis and morbili and it is important for bronchiectasis prognosis.for patients with bronchiectasis made the effort to prevent people from avoiding ingredients that canstimulate the production of excessive secretions. Avoiding irritants away from the material, sleeping pillsand drugs that suppress cough.Complication bronchiectasis1. PneumoniaOften develop recurrent exacerbations of upper respiratory tract infections. These infections ofteninvolve abnormal bronchial area.2. PleuritisPleural pain may arise in conjunction with pneumonia usually develops from the upper respiratory tractinfection.3. Pleural effusion or empyemaPleural effusion or empyema is relatively rare in bronchiectasis.4. SinusitisSinusitis is a common complication of bronchiectasis and almost certainly occurs in severe cases.5. HemoptysisHemoptysis sometimes occurs in bronchiectasis, and most often is mild hemoptysis. In recurrenthemoptysis and uncontrolled, is an indication for resection. Location of the source of bleeding issometimes difficult to determine.6. Brain abscesswww.bronchiectasisprognosis.com
  11. 11. A brain abscess is a complication of chronic bronchiectasis. Once this is the worst cause of death.Whenthese complications are extremely rare.7. AmyloidosisAlthough amyloidosis is a very rare complication, but this possibility should still be considered. In theevent of an enlarged liver or spleen, the possibility of amyloidosis should be considered.Bronchiectasis PrognosisAt the time of modern medicine has not been introduced, the bronchiectasis prognosis is poor, withbronchiectasis modern treatment, medical or surgical prognosis (life expectancy) was good but thisdisease cannot be cured completely.Conclusion bronchiectasis1. Clinical manifestations of signs and symptoms depending on severity of bronchiectasis include chroniccough, recurrent disease, with recurrent, repetitive coughing up blood and coughing up bloodsometimes massive On examination found shortness of breath, clubbing and crackles wet.2. The diagnosis of bronchiectasis often can be established from a history of recurrent productivechronic cough, recurring fever, coughing up blood repeatedly with cystic image with or without waterfluid levels on plain chest X-ray or tomogram. To determine a definitive diagnosis bronkografiexamination.3. Antibiotics are given when there is an increased amount of sputum, and no change in the nature ofthe mucous sputum becomes purulent. antibiotics should be adjusted with the results of resistancetesting.4. granting mucolytic beneficial in patients with bronchiectasis. Expectorant unclear benefits.5. Physiotherapy greatly helps remove secretions from the airways.6. Surgery is only done if there is recurrent infection, recurrent coughing up blood and coughing upblood massive.Hopefully this article on bronchiectasis prognosis of benefit to you.www.bronchiectasisprognosis.com