4. DEFINITION:
Bronchiectasis is defined as
abnormal and irreversible dilatation of
the bronchi and bronchioles (greater
than 2mm in diameter) developing
secondary to inflammatory weakening
of bronchial walls.
8. ACQUIRED CAUSES
Tuberculosis,
pneumonia,
inhaled foreign bodies,
allergic bronchopulmonary aspergillosis and
bronchiol tumours are the major acquired
causes of Bronchiectasis.
9. INFECTIVE CAUSES ASSOCIATED WITH
BRONCHIECTASIS INCLUDE
infections caused by
the Staphylococcus,
Klebsiella, or
Bordetella pertussis,
the causative agent of
whooping cough.
10. ASPIRATION OF AMMONIA AND OTHER TOXIC
GASES,
pulmonary aspiration,
alcoholism, heroin (drug use),
various allergies all appear to be linked
to the development of Bronchiectasis
11. Childhood Acquired Immune Deficiency
Syndrome (AIDS), which predisposes patients
to a variety of pulmonary ailments, such as
pneumonia and other opportunistic infections.
Inflammatory bowel disease, especially
ulcerative colitis.
A Hiatal hernia can cause Bronchiectasis when
the stomach acid that is aspirated into the
lungs causes tissue damage.
12. CONGENITAL CAUSES
Kartagener syndrome
primary immunodeficiencies
Williams-Campbell syndrome and Marfan’s
syndrome.
Patients with alpha 1-antitrypsin deficiency
have been found to be particularly
susceptible to bronchiectasis,
14. Three different patterns of bronchiectasis have been
described
cylindrical bronchiectasis: the involved bronchi
appear uniformly dilated
varicose bronchiectasis: the affected bronchi have an
irregular or beaded pattern of dilatation resembling
varicose veins
PATTERNS OF BRONCHIECTASIS
17. Saccular (cystic) bronchiectasis:
The bronchi have a ballooned appearance at the
periphery, ending in blind sacs without
recognizable bronchial structures distal to the
sacs
21. Due to etiological factor
Inflammation of bronchial wall
causing
Loss of supporting structure
Result in
Thick sputum that obstruct the bronchi
The bronchial wall become
permanently dialated and distorted
26. CLINICAL MANIFESTATION
1. The production of large quantities of purulent
and often foul-smelling sputum.
The volume of sputum can be used for
estimating the severity of the disease
Mild < 10 mL
Moderate 10~150 mL
Severe >150 mL
27. 2. Chronic cough
3. Hemoptysis:
Frequent
More commonly in dry variety
Usually mild (blood streaking of purulent
sputum)
Massive hemoptysis is usually from
dilated bronchial arteries or bronchial-
pulmonary anastomoses under systemic
pressure
29. SIGNS AND SYMPTOMS
Chronic cough with foul smelling sputum
production,
Some people with bronchiectasis may
produce frequent green/yellow sputum (up to
240ml (8 oz) daily).
Bronchiectasis may also present with
hemoptysis
Pneumonia
Bad breath indicative of active infection.
Frequent bronchial infections and
breathlessness are two possible indicators of
30. DIAGNOSTIC EVALUATION:
History and physical examination
Chest x-ray
CT (computerised tomography) scan
Blood tests
Testing of the mucus to identify any bacteria
present
Checking oxygen levels in the blood
Lung function tests (spirometry).
35. TREATMENT
Treatment of bronchiectasis includes
controlling infections and bronchial
secretions,
relieving airway obstructions,
removal of affected portions of lung by
surgical removal or artery embolization
preventing complications.
36. TREATMENT
Therapy has several major goals:
(1)Treatment of infection, particularly during acute
exacerbations
(2) Improved clearance of tracheobronchial secretions
(3) Reduction of inflammation
(4) Treatment of an identifiable underlying problem
38. 2. Antibiotic
The choice of antibiotics should be
accurately by the results of sputum
culture and drug sensitivity test.
Empirical therapy ---
antipseudomonal antibiotics.
39. ANTIBIOTICS ARE THE CORNERSTONE OF BRONCHIECTASIS
MANAGEMENT
Antibiotics are used only during acute
episodes
Choice of an antibiotic should be guided by
gram's stain and culture of sputum
Empiric coverage (amoxicillin, co-
trimoxazole,levofloxacin) is often given
initially
40. BRONCHODILATER
Bronchodilators to improve
obstruction and aid clearance
of secretions are useful in
patients with airway
hyperreactivity and reversible
airflow obstruction
41. Surgical management is indicated
1. Recurrent and refractory clinical
symptoms are due to a focal area
of disease involvement.
2. Massive hemoptysis
Management of hemoptysis
42. Surgical resection
Bronchial arterial embolization
Although resection may be successful if disease
is localized, embolization is preferable with
widespread disease
43. NURSING MANAGEMENT:
History and physical examination
Obtain history regarding amount
and characteristics of sputum
produced, including haemoptysis.
Auscultate lungs for diffuse rhonchi
and crackles.
