APPROACH TO

BRONCHIECTASIS
Lecturer: Dr Thair Mousa Ghazi

NAME STUDENT ID
ZULAIHA BINTI FAROOK SULTAN 012019040013
NURUL AMIRA BINTI MOHD ALI 012019040019
NAJIHAH BINTI MOHAMAD SANY 012019040025
NOOR ATIQAH ANATI BINTI ABD RAHMAN 012019040026
 TOPIC LEARNING OUTCOMES

Definition 04 Investigations

02 Aetiology & 05 Management

Pathology

03 Clinical features 06 Complications

 01
DEFINITION
Prepared by:
ZULAIHA BINTI FAROOK SULTAN
(012019040013)
 DEFINITION OF BRONCHIECTASIS
❑ Abnormal dilatation of bronchi
❑ Chronic suppurative airway infection with sputum production, progressive
scarring and lung damage
 02
AETIOLOGY &
PATHOLOGY
Prepared by:
ZULAIHA BINTI FAROOK SULTAN
(012019040013)
AETIOLOGY OF BRONCHIECTASIS

• Localized bronchiectasis: due to

accumulation of pus beyond
obstructing bronchial lesion
✓ enlarged tuberculous hilar
lymph node
✓ bronchial tumour
✓Inhaled foreign body
 PATHOLOGY OF BRONCHIECTASIS
Bronchiectatic cavities
lined by granulation Inflammatory changes in
Hypertrophy of bronchial
tissues, squamous deeper layer of bronchial
arteries
epithelium or normal wall
ciliated epithelium

Chronic inflammatory and

Progressive destruction of
fibrotic changes in
normal lung architecture
surrounding lung tissue
(advanced cases)
(advanced cases)
 03
CLINICAL
FEATURES Prepared by:
ZULAIHA BINTI FAROOK SULTAN
(012019040013)
CLINICAL FEATURES OF BRONCHIECTASIS
SIGNS OF BRONCHIECTASIS

• Finger clubbing
• Coarse crackles: large amount of
sputum
• Diminished breath sounds: if
collapse with retained secretions
block proximal bronchus
• Bronchial breathing: in advanced
disease with scarring
• No physical signs if:
✓ No lobar collapse
✓ Bronchiectatic airway do not
contain secretions
 04
INVESTIGATIONS
Prepared by:
NURUL AMIRA BINTI MOHD ALI
(012019040019)
INVESTIGATIONS FINDINGS

Sputum • Reveal Pseudomonas aeruginosa and

examination and Staphylococcus aureus, and fungi such as
culture Aspergillus and various mycobacteria.
• To ensure appropriate treatment of
resistant organisms.

Chest X-Ray • Not usually apparent (unlike very gross).

• In advanced disease:
✓ Thickened airway walls.
✓ Cystic bronchiectatic spaces.
✓ Associated areas of pneumonic
consolidation or collapse.
CT scan of bronchiectasis
showing extensive dilatation of
Computed • More sensitive. bronchi, with thickened walls
(arrows) in both lower lobes.
Tomography (CT) • Shows thickened, dilated airways.
scan
 INVESTIGATIONS FINDINGS

Mucociliary clearance • Screening test in patients suspected of having a ciliary dysfunction

(Nasal clearance of syndrome.
saccharin) • A small pellet of saccharin is placed in the anterior chamber of the
nose and measure the time taken for it to reach the pharynx – at
point when the patient can taste it.
• Time taken should not exceed 20 minutes – greatly prolonged in
patients with ciliary dysfunction.

Bronchial biopsy and • Ciliary beat frequency may be assessed from biopsies.
electron microscopy of • Structural abnormalities of cilia can be detected by electron
cilia microscopy.

Serum immunoglobulins • 10% of adults with bronchiectasis have antibody class or subclass
deficiency (mainly IgA).
• Immune deficiency may be identified by impaired vaccine response
to Haemophilus influenzae type B and pneumococcal vaccines.
• Some have normal antibody class levels but fail to respond to
respiratory pathogens.
 05
MANAGEMENT
Prepared by:
NAJIHAH BINTI MOHAMAD SANY
(012019040025)
1. Airway clearance
• Daily airway clearance therapy is advised

a. Activated cycle of breathing technique

o clearance of excess secretions from the lungs
o improving ventilation of the lungs
o ACBT has three components:
✓ breathing control
✓ thoracic expansion exercises
✓ The forced expiration technique-Huffing
b. Autogenic self-drainage
• an airway clearance technique which utilizes controlled breathing
at different lung volumes to loosen, mobilize and move secretions
in three stages towards the larger central airways

o Stage 1 – low volume breaths

to mobilize secretions from
the peripheral airways
o Stage 2 – medium (tidal)
volume breaths to collect
mucus from the middle airways
o Stage 3 – large volume breaths
enabling expectoration from
central airways
c. Postural drainage
• the positioning of a
patient with an
involved lung segment
such that gravity has a
maximal effect of
facilitating the drainage
of broncho-pulmonary
secretions from the
tracheobronchial tree.
• Device: Flutter or Acapella
2. Anti-inflammatory agents
• Long term azithromycin has immunomodulatory effect and reduce exacerbation
frequency.
• Inhaled corticosteroids are beneficial to some patients.
3. Antibiotics
Pseudomonas aeruginosa- dual therapy
• High dose Ciprofloxacin (750 mg twice daily) orally
Hemophilus influenza- common
• Oral antibiotics: amoxicillin, co-amoxiclav or doxycycline.
Some multi-resistant species need iv cephalosporin treatment.

4. Bronchodilators
• Bronchodilators are useful in patients with demonstrable airflow limitation.

5. Surgery
• Removal of the bronchiectasis part of the lung for symptoms of bleeding, recurrent
infection or copious symptoms can be very effective when the disease is localized.
• Lung or heart-lung transplantation is sometimes required.
 06
COMPLICATIONS
Prepared by:
NOOR ATIQAH ANATI BINTI ABD
RAHMAN
(012019040026)
 PROGNOSIS
• Prognosis variable depending on severity of diseases.
• Mild disease have normal life expectancy and prognosis is good with if
physiotherapy is performed regularly and antibiotic is used aggressively.
• Disease is progressive if associated with ciliary dysfunction and cystic fibrosis which
eventually can lead to respiratory failure.
• A lower FEV1 and infection with Pseudomonas Aeruginosa is associated with poorer
outcomes.
• Severe bronchiectasis can develop respiratory failure and cor pulmonale.
 COMPLICATIONS
• Incidence of complications has decrease with antibiotic therapy.
• Common complications that can occur: recurrent
pneumonia, pneumothorax, empyema, respiratory failure and cor pulmonale.

• Other complications;
✓ Acute / massive hemoptysis which cause by pulmonary tuberculosis (most
common), aspergilloma, lung abscess and primary and secondary malignant
tumors.
✓ Amyloidosis & metastatic cerebral abscess (now rare because of the advanced
antibiotic therapy)
 TREATMENT FOR COMPLICATIONS
1. Patients with reduced exercise capacity • Offered pulmonary rehabilitation
& breathlessness

2. Massive hemoptysis • Life threatening medical emergency

• Mild hemoptysis; simply bed rest and
antibiotic. Usually will stop bleeding
and respond to treatment for underlyig
causes.
• For massive hemoptysis, resuscitation
with airway protection until bronchial
artery embolization can be performed.
• If not successful, surgery.
3. Respiratory failure • Oxygen and non-invasive ventilation
• Suitable patients can opt for transplant
 REFERENCES
1. Ralston, S. H., Penman, I. D., Strachan, M. W. J., & Hobson, R. (Eds.). (2018).
Davidson's principles and practice of medicine (23rd ed.).
2. Parveen Kumar & Michael Clark. (2012). Kumar & Clark's Clinical Medicine 8th
Edition.
Thank You!