CASE STUDY: BRONCHIECTASIS

BRONCHI = bronchus of the lungs (airway)

ECTASIS = dilatation

Bronchiectasis is a term that describes a chronic abnormal and permanent dilatation of the walls of
the bronchial tree. This damage impairs the natural drainage of bronchial secretions which can become
chronically infected resulting in mild to moderate airway obstruction. It is characterized by an increased
amount of sputum production and gradual loss of lung function leading to shortness of breath. This may be
congenital or acquired. It can either be in a focal or diffuse manner and that has been categorized as
cylindrical, varicose, or cystic.
PATTERN OF LUNG INVOLVEMENT BY BRONCHIECTASIS:
1. FOCAL - bronchiectatic changes in a localized area of the lung due to obstruction because
of a tumor, foreign body or enlarged lymph nodes.
2. DIFFUSE - bronchiectatic changes throughout the lung and often arises from an underlying
systemic or infectious disease.

BRONCHIECTASIS can be classified into the following forms morphologically. All forms may be present in
the same patient.

Cylindrical Bronchiectasis

Most common
Bronchi are enlarged and cylindrical.
Distal airways end abruptly, owing to mucus plugging
Parallel tram-track lines are seen on CXR or CT
scan
CT cross-section views reveal 'signet ring'
appearance of the
dilated bronchus and its accompanying vessel.
Varicose Bronchiectasis
 Relatively uncommon
Bronchi are irregular with areas of dilatation and constriction.
Bronchographic pattern resembles varicose veins.

Saccular or Cystic

Dilated bronchi form clusters of cysts. It is the most severe form of

bronchiectasis and is often found in patients with cystic fibrosis.
Bronchial tree ends in blind sacs

HISTORY:

First described by Laennec in 1819, later detailed by Sir William Osler in the late 1800s and further
defined by Reid in the 1950s. Rene Theophile Hyacinthe Lannec (17811826) was a French physician
who, in 1816, invented the stethoscope and investigated the sound made by the heart and lungs using this
new instrument. He wrote the first descriptions of bronchiectasis and cirrhosis and also classified
pulmonary conditions such as pneumonia, bronchiectasis, pleurisy, emphysema, pneumothorax and other
lung diseases from the sounds he heard with his invention. Reid was the one who described the three
morphological types of bronchiectasis.

STATISTICS/EPIDEMIOLOGY:

Bronchiectasis, a common and often fatal illness in the preantibiotic era, has become a rare
disease over the past decades in developed countries. According to an article of Emmons (2016), the
prevalence of bronchiectasis depends on the socioeconomic conditions of the population under study.
There is lower prevalence of this disease in areas where vaccines and antibiotics are readily available
compared to less-developed countries where bronchiectasis is one major cause of morbidity because of
lack in medical care and antibiotic therapy. In a childrens hospital in UK, the admission rate for patients
with bronchiectasis had decreased from about 48 per 10,000 admissions to 10 per 10,000 admissions
between the year 1952 and 1960. At the Massachusetts General Hospital, the number of patients with
bronchiectasis has declined from 45 in 1947 to about 9 in 1984 (Fisherman, 1988)..
Bronchiectasis may affect anyone at any age but most common in older people aged 60-80 years
old. More women develop bronchiectasis than men do. However, in children, the condition is more common
in boys than girls are. A large study across 640 general practices in the UK published in 2012 found that the
prevalence of this disease was higher in women than in men and higher in older age groups (>60 years).

(YUNG SA PHILIPPINES PA, KUNG MERON)

CAUSES/ETIOLOGY:

RISK FACTORS:

1. Tuberculosis, tobacco smoking and exposure to indoor air pollution

Tuberculosis, tobacco (saang lugar makikita?) smoking and exposure to

indoor air pollution contributes towards higher morbidity of this diseases. Other suggested
that increased smokers, urbanization and air pollution are associated to the prevalence of morbidity and
mortality of respiratory diseases.

2. Gender
Women are at high risk of bronchiectasis. According to the study by the
University of California-Davis School of Medicine, bronchiectasis in women may act more virulently. There
is sufficient evidence to suggest that chronic airway infection, most notably non-CF bronchiectasis, is a
more common and more virulent disease in women.

3. Delay diagnosis
In the study to provide advice regarding when to suspect bronchiectasis, how to proceed with
confirming a diagnosis, and the principles of management to minimize disease progression, found that
delay in the diagnosis, investigation and management of bronchiectasis in both children and adults is
common, and this delay has been shown to be associated with more rapid progression of disease.
REFERENCES:
http://beforeitsnews.com/health/2013/01/most-common-diseases-of-age-50-bronchiectasis-respiratory-
disease-the-risk-factors-2465540.html
Sialitarana, Santi. (2014). Bronchiectasis causes and diagnosis. Retrieved from:
http://www.slideshare.net/nautsilairatana/bronchiectasis-causes-and-diagnosis
BMJ Best Practice. (2015). Classifications of Bronchiectasis. Retrieved from:
http://bestpractice.bmj.com/best-practice/monograph/1007/basics/classification.html
Roguin, A. (2006). Rene Theophile Hyacinthe Lannec (17811826): The Man Behind the
Stethoscope. Clinical Medicine and Research, 4(3), 230235.
National Heart and Lung Institute. (2014). Bronchiectasis. Retrieved from:
http://www.nhlbi.nih.gov/health/health- topics/topics/brn/atrisk

Fishman, Alfred P. (1988). Pulmonary Diseases and Disorders (2nd Ed.). Mc-Graw Hill Inc.: United States of
America
Emmons, Ethan E. (2016). Bronchiectasis. Retrieved from: http://emedicine.medscape.com/article/296961-
overview#a5

Gaillard, Frank. (2015). Bronchiectasis. Retrieved from: https://radiopaedia.org/articles/bronchiectasis

MERON PA..