Download - Bronchiectasis
BRONCHIECTA
SIS
OUTLINE
Definition
Causes
Clinical Manifestation
Workup
Management
BRONCHIECTASIS IS
Chronic necrotizing infection of the bronchi and bronchioles leading to abnormal, permanent dilatation of the airways
EPIDEMIOLOGY
Prevalence unknown due to the lack of observational studies in the population but vary substantially based on country
Common trends: The prevalence of bronchiectasis increases with age Bronchiectasis is more common in women Patients with bronchiectasis use extensive healthcare resources
(frequent admissions, antibiotics usage, HRCT etc)
PATHOPHSYIOLOGY
Requires two factors for the induction of bronchiectasis An infectious insult Impaired drainage, airway obstruction, or a defect in host defense
Abnormal wall dilatation, destruction and transmural inflammation
CAUSES
Respiratory Infections Pertussis Measles Tuberculosis Severe bacterial pneumonia
Bronchial Obstruction Foreign Body Chronic Aspiration Endobronchial Tumor Lymph nodes (TB, sarcoidosis, and malignancy) Granulomata (TB, sarcoidosis and malignancy)
CAUSES
Fibrosis Long standing pulmonary fibrosis Fibrosis complicating TB and sarcoidosis Fibrosis complicating unresolved or suppurative pneumonia
Muco-ciliary clearance defects Cystic Fibrosis Immotile Cilia syndrome Kartagener syndrome Young syndrome
CAUSES
Immunodeficiency Congenital and acquired hypogammaglobulinemia AIDS
Allergic Bronchopulmonary Aspergillosis
Autoimmune Disease Rhematoid Arthritis Sjogren Syndrome IBD
CLINICAL MANIFESTATION
Symptoms Cough with thick mucoid sputum Dyspnea Chest pain Fever
CLINICAL MANIFESTATIONS
Signs Clubbing Coarse Crepitations which alters with coughing Inspiratory clicks Rhonchi Signs of cor pulmonale
IX WORKUP
FBC
Sputum C+S
Immunoglobulin quantitation
Mutation analysis of the cystic fibrosis transmembrane conductance regulator (CFTR) gene
IMAGING
CXR
HRCT
MANAGEMENT
General Measures Stop smoking Adequate nutritional intake and supplementation if necessary Immunizations for influenza and pneumococcal pneumonia LTOT
MANAGEMENT (CONT.)
Physiotherapy and postural drainage
Antibiotics Empirical. BTS recommends 14 day course If previous sputum C+S results were known, can be used to guide
current exacerbation
Bronchodilator Therapy
Anti Inflammatory Medications
MANAGEMENT (CONT.)
Surgery Surgical resection for localised bronchiectasis (poorly controlled by
antibiotics) Bronchial artery embolization for massive hemoptysis Foreign body or tumour removal Lung transplamnt in patients with Cystic Fibrosis