Synthesis of the disease
The inflammatory process associated with frequent pulmonary infections damages the bronchial wall,causing a loss of its supporting structure and resulting in thick sputum that ultimately obstructs the bronchi. The walls become permanently distended and distorted, impairing mucociliary clearance. Theinflammation and infection extend to the peribronchial tissues; in the case of saccular bronchiectasis, eachdilated tube virtually amounts to a lung abscess, the exudates of which drains freely through the bronchus.Bronchiectasis is usually localized, affecting a segment or lobe of a lung, most frequently the lower lobes.The retention of secretions and subsequent obstruction ultimately cause the alveoli distal to theobstruction to collapse (atelectasis). Inflammatory scarring or fibrosis replaces functioning lung tissue. Intime, the patient develops respiratory insufficiency with reduced vital capacity, decreased ventilation, andan increased ratio of residual volume to total lung capacity. There is impairment in the matching of ventilation to perfusion (ventilation-perfusion imbalance) and hypoxemia.
Predisposing / Precipitating factors
Bronchiectasis may be caused by a variety of conditions, including pulmonary infections and obstructionof the bronchus diffuse airway injury; genetic disorder (e.g, cystic fibrosis); and abnormal host defense(e.g, humoral immunodeficiency). A person may be predisposed to bronchiectasis (history of recurrentinfections, measles influenza, tuberculosis, and immunodeficiency disorders).
Signs and symptoms
Clinical manifestations includes chronic cough and production of copius purulent sputum, which has aquality of “layering out” into three layers on standing a frothy top layer, a middle clear layer, and a dense particulate bottom layer. Hemoptysis, clubbing of fingers, and repeated episodes of pulmonary infectionsare also manifested.
RespiratoryinsufficiencyIncreased ratio of residual volume tototal lung capacityDecreasedventilationReduced vitalcapacityCyanosis (clubbing of fingers)HypoxemiaVentilation – perfusionimbalance