bronchectasis

Examination findings in bronchectasis :

a. G.look:
- Equipements : sputum pot. / oxygen .
- FTT.
- +/- tachypnea
b. Hand :
- Clubbing
c. Head and neck
- +/- central cyanosis.
- +/- halitosis.
d. Chest :
- Inspection : (as example if right side lobectomy)
o RT. Site of chest moving less.
o +/- Signs of RD.
o RT. Lateral thoracotomy scar
o Hyper expanded chest
- Palpation :
o Apex and trachea deviated to right site.
o Rt. Site of chest moving less.
- Percussion :
o normal percussion note.
- Ausclation:
o Crepitations all over
o Air entery is less on the right side.
e. In order to continue examination:
- Examine the back
f. I want To complete my examination by :
- ENT examination
- Check for Lymph node .
- Plot him in growth chart
- Peak flow meter.

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 Discussion

What is chronic supprative lung disease ?

- Chronic suppurative lung disease" CSLD" is used to describe a range of

lung diseases characterized by a chronic wet cough and progressive lung
damage.
- Criteria to diagnose chronic supperative lung disease :
 chronic wet/productive cough 8wks/yr,
 FTT ,
 clubbing ,
 cyanosis ,
 Hyper expansion chest .

What is difference between chronic supperative lung disease and bronchiectasis?

1. Bronchiectasis : is a clinical syndrome in a child or adult with the chronic

symptoms and/or signs of wet and productive chest , and presence of
characteristic radiographic features on chest high-resolution computed
tomography (c-HRCT).
2. CSLD (clinical diagnosis) is a clinical syndrome in children with the
symptoms and/or signs of chronic wet and productive , but who lack a
radiographic diagnosis of bronchiectasis.

Forms / causes of Chronic supperative lung disease "CSLD":

- Cystic fibrosis.
- 1ry ciliary dyskinesia
- Bronchiectasis (due to any causes) : it is severe form of CSLD with
radiological changes.
- Lung abscess.

Patho physiology of bronchiectasis :

- Ch. Airway obstruction ⤍ Infection of Retained secretions ⤍ Dilated

airways.
- Mainly Lower Lobes then middle and follow by upper lobe.
- Presentation like cystic fibrosis.

Causes of bronchiectasis:

1. Immunodeficiency (hyper IgE syndrome , AIDS , IgA def. ,

hypogamaglobunemia).

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 2. cystic fibrosis.
3. 10 Ciliary Dyskiasia.
4. alfa 1 – antitrypsin def
5. F.B.
6. post Infection (Staph/ Strept / T.B./measles /pertusis)
7. Bronchiolitis Obliterance (R.S.V. / Pertussis / Adeno-V.)
8. Recurrent Aspiration (C.P. / T.O.F)
9. Asthma/tracheobronchomalacia.
10. Bronchial compression( airway lymphadenopathy /tumors).
11. lobar sequestration.
12. Rare syndromes : macleod's , klinefelter's , gardner's.

What are investigations incase for bronchectasis ?

- To confirm bronchectasis :
 by C.XR.
 Confirmed by High-Resolution C.T. ± Bronchoscopy.
- To search for aetiology :
 C x-ray /Bronchoscopy ……foreign body
 Sweat test …..cystic fibrosis
 Immunoglobulins ……..imunodef.
 Saccharin test ………..1ry ciliary dyskinesia.
 Alfa 1 antitrpsin profile-phenotype.
 Investigate for TB

Management of bronchectasis :

multidiscplenary approach

1. Pediatrician and pediatric pulmonolgist as team leader for :

 Treatment of underlying pathology.
 Antibiotic to treat infection
 Bronchodilators.
 Mucolytics (DNase)/hypertonic saline.
2. Physiotherapist : Regular Physiotherapy chest.( postural drainage , chest
PT by manual or vibrator).
3. Dietien who Increase caloric intake.
4. Chest surgeon : for Lobectomy : the left lower lobe is commonest site for
lobectomy because of poorest drainage .
5. Immunizations(influenza) .
6. education , aids compliance with treatment.

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How you follow pt with bronchectasis ? F/Up for :

- Spirometery .
- Sputum culture
- Nutrition and growth.
- Cor-Pulmonale.

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