INTRODUCTION:
Bronchiectasis means abnormal dilatation of the bronchi due to chronic airway inflammation and infection. It is usually acquired, but may result from an underlying genetic or congenital defect of airway defences.
CAUSES:
Congenital
• Cystic fibrosis
• Primary ciliary dyskinesia
• Kartagener’s syndrome (sinusitis and transposition of the viscera)
• Primary hypogammaglobulinaemia
Acquired
• Pneumonia (complicating whooping cough or measles)
• Inhaled foreign body
• Suppurative pneumonia
• Pulmonary TB
• Allergic bronchopulmonary aspergillosis complicating asthma
• Bronchial tumours
CLINICAL FEATURES:
● Chronic cough productive of purulent sputum.
● Pleuritic pain.
● Haemoptysis.
● Halitosis.
Acute exacerbations may cause fever and increase these symptoms. Examination reveals coarse crackles caused by sputum in bronchiectatic spaces. Diminished breath sounds may indicate lobar collapse. Bronchial breathing due to scarring may be heard in advanced disease.
INVESTIGATIONS:
Sputum: Testing may reveal common respiratory pathogens. As disease progresses, Pseudomonas aeruginosa or fungi such as Aspergillus and various mycobacteria may be seen. Frequent cultures
assist appropriate antibiotic selection.
Radiology: CXR may be normal in mild disease. In advanced disease, thickened airway walls, cystic bronchiectatic spaces, and associated areas of pneumonic consolidation or collapse may be seen. CT is much more sensitive and shows thickened dilated airways.
Assessment of ciliary function: Saccharin test or nasal biopsy may be used.
MANAGEMENT AND PROGNOSIS:
In patients with airflow obstruction, inhaled bronchodilators and corticosteroids may enhance airway patency.
Physiotherapy: Patients should perform regular daily physiotherapy to keep the dilated bronchi empty of secretions. Deep breathing followed by forced expiratory manoeuvres (‘active cycle of breathing’ technique), and devices that generate positive expiratory pressure (PEP mask or flutter valve) can assist with sputum clearance.
Antibiotics: In most patients with bronchiectasis, the same antibiotics are used as in COPD, although higher doses are needed. In patients colonised with staphylococci and Gram-negative bacilli, especially Pseudomonas spp., antibiotic therapy should be guided by microbiology results. Regular macrolides help reduce exacerbations in some patients with bronchiectasis, but their use is not yet supported
by large trials (except in cystic fibrosis).
Surgical treatment: Surgery is only indicated in a few cases where bronchiectasis is unilateral and confined to a single lobe/segment on CT.
The disease is progressive when associated with ciliary dysfunction and cystic fibrosis, and eventually causes respiratory failure. In other patients, the prognosis can be good with regular physiotherapy
and judicious use of antibiotics. Bronchiectasis may be prevented by prophylaxis or treatment of common causes, e.g. measles, whooping cough, TB.
THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND
WEBSITES..
(DAVIDSON’S ESSENTIALS OF MEDICINE)
THANK YOU,
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