Bronchiectasis

Definition:
Bronchiectasis (bronchi=bronchial;ectasis=widening)..
Chronic dilatation of bronchial tubes..

Classification of Bronchiectasis:
1. Cylindrical Bronchiectasis
2. Fusiform Bronchiectasis
3. Cystic or Saccular Bronchiectasis

Etiology of Bronchiectasis( causes)

Primary ( Congenital)

Secondary ( due to various disease of bronchi,lungs and pleura)

 

Congenital

1. Kartagener syndrome, which affects the mobility of cilia in the lungs.

2. Cystic fibrosis, in which a small number of patients develop severe localized bronchiectasis. 

3. Young's syndrome, which is clinically similar to cystic fibrosis, is thought to significantly contribute to the development of bronchiectasis. This is due to the occurrence of chronic, sinopulmonaryinfections. 

4. Primary immunodeficiencies, due to the weakened or nonexistent immune system response to severe, recurrent infections that commonly affect the lung.

5. Williams-Campbell syndrome and Marfan syndrome.

 

Acquired

1. AIDS

2. Tuberculosis

3. Bronchial obstruction( tumour, foreign bodies)

4. Environmental exposures include respiratory infections,inhalation and aspiration of Ammonia and other toxic gases, pulmonary aspiration, alcoholism, heroin(drug use),

5. various allergies

6. Allergic bronchopulmonary aspergillus(ABPA)

7. rheumatoid

8. arthritis

9. ulcerative colitis

10.idiopathic

 

Clinical bronchiectasisBronchiectasis is a disease that is often found at age 20-40.

More common in men than women.

 

Signs and Symptoms of Bronchiectasis

1. Chronic Cough With Large Amounts of Thick, Foul-Smelling Sputum

A persistent, long-term cough with copious amounts of thick, purulent sputum are the hallmark symptoms of bronciectasis. With the presence of infection, the mucus is often discolored, foul-smelling and may even contain blood. Around 50-500ml and more sputum exporated per day.

2. Hemoptysis

People with bronchiectasis may sometimes cough up small amounts of blood. This term is referred to as hemoptysis. Hemoptysis is due, primarily, to the rupturing of tiny blood vessels near the surface of bronchial tubes. Normally, this bleeding is minor, but occasionally requires emergent care. When hemoptysis does occur, it usually indicates further infection.

3. Dyspnea

Dyspnea, or shortness of breath, is another common symptom of bronchiectasis which occurs because of the blockage of the airways with mucus. Typically, dyspnea worsens with exertion or exercise

4. Weight Loss

Weight loss may occur because of the added caloric demand made by the body as a result of long-term, excessive coughing.

5. Fatigue

Fatigue is an overall feeling of tiredness or lack of energy. In the case of bronchiectasis, one of the causes of fatigue may be lack of sleep caused by long-term excessive coughing. Sometimes, medication side effects can mimic fatigue and are common with antihistamines, blood pressure medicines, sleeping pills, steroids, or diuretics.

6. Weakness

Weakness is a common symptom of many chronic illnesses. The weakness caused by bronchiectasis is basically generalized, meaning it affects the entire body, as opposed to localized weakness, which affects only a specific limb, muscle group, or one side of the body.

7. Clubbing of the Fingers

Clubbing is a sign of long-term oxygen deprivation and may, or may not, be seen in bronchiectasis. Initially, it manifests itself as sponginess of the nail bed along with loss of the nail-bed's angle, causing the nail bed to curve downward.

8. Wheezing

Often described as a whistling sound heard during inhalation or exhalation, wheezing is caused by a narrowing or blockage of the airways. Oftentimes, wheezing can be so prevalent that you can hear it without the assistance of a stethoscope.

9. Repeated Lung Infections

Respiratory infections are common in bronchiectasis and may include bacterial infections (such as staphyloccus) fungal infections (such as aspergillosis) mycobacterial infections (such astuberculosis) or viral infections (such as influenza). If lung infections are treated immediately, bronchiectasis is less likely to occur.

10. Cough
-mainy in morning

11. Excess sweating

Examination:
1. Chest: normal shape or emphysematous

2. Percussion : pulmonary, with a bandbox tone (due to concurrent emphysema), less frequent with tympanic tone ( over bronchiectatic area).

3. Respiration sound :
-harsh or decrease vesicular( due to emphysema)
-dry and sometimes fine and moderate bubbling non-consonant rales are heard over bronchiectatic area.
-pleural fiction can be heard if inflammation extends onto pleura and in presence of pleura adhesion.

4. General inspection:
-Acrocyanosis(at later stages of disease) and oedematous face
-clubbing finger
-nails resemble watch glass

5. Spirometer: decrease vital capacity

 


Post-infection:
measles, pertusis, bronchilotis,pneumonia,tb,HIV

Management:
1. Postural drainage perform twice daily.
2. Antibiotics
3. Bronchodilators (ed. nebulized salbutamol) useful for asthma ,COPD,CF,ABPA
4. corticosteroid (eg prednisolone)for ABPA
5. Surgery