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Categories of Respiratory Disease .

Definition • The term bronchiectasis is derived from the Greek words bronkia (bronchial tubes). . ek (out).” • The condition is generally defined as an abnormal and permanent dilatation of the cartilage-containing airways (bronchi). and tasis (stretching). which together literally mean “the outstretching of the bronchi.

varicose. or cystic. .• Bronchiectasis refers to an irreversible airway dilation that involves the lung in either a focal or a diffuse manner and that classically has been categorized as cylindrical or tubular (the most common form).

.Prevalence • The true prevalence of bronchiectasis is unknown for most regions of the world.

Etiology .

.• The main bacterial pathogens that are commonly isolated are Haemophilus influenzae (29%–70%) followed by Pseudomonas aeruginosa (12%–31%). • Additional microorganisms that may be encountered include Streptococcus pneumoniae. Haemophilus parainfluenzae. and Moraxella catarrhalis. Staphylococcus aureus.

“ by Professor Peter Cole. the mucociliary escalator mechanism. which facilitated persistent bacterial colonization and infection. compromised host clearance mechanisms and. such as an infection. in particular. .Patogenesis • The most widely cited mechanism of infectious bronchiectasis is the "vicious cycle hypothesis. proposed that an initial airway insult. often on the background of genetic susceptibility.

Patology • Classic studies of the pathology of bronchiectasis from the 1950s demonstrated significant smallairway wall inflammation and larger-airway wall destruction as well as dilation. smooth muscle. . with loss of elastin. and cartilage.

• Hemoptysis • Chest pain. tenacious sputum.Clinical Manifestations • A persistent productive cough with ongoing production of thick. • Decreased effort tolerance. . • Dyspnea.

Physical Finding • Crackles and wheezing in the lung auscultation • Clubbing of the digits .

• Classical clinical triad: – Chronic cough – Excess sputum production – Repeated infection .

• Sputum examination .identification of a pathogen and characterization of its antimicrobial susceptibility pattern would aid in decisions regarding antibiotic therapy. .

Radiographic Interpretation : • Ring opacities on both of lung like “honeycomb appearance” .

Interrnal diameter of the bronchus is wider than the adjacent pulmonary artery (ie. Bronchi being visualized in the outer 1 to 2 cm of the lung fields. . • The most specific HRCT scanning findings suggestive of bronchiectasis are: 1. 2. Failure of the bronchi to taper.High-Resolution CT (HRCT) scaning of the chest • High-resolution CT (HRCT) scanning of the chest. which has become the gold standard for the diagnosis. signet ring formation). and 3.

demonstrated with HRCT scan of the chest.High-Resolution CT (HRCT) scaning of the chest Severe cystic bronchiectasis in the right lower lobe of an adult patient. .

Therapy • General health measures such as adoption of good nutrition. non-smoking strategy. and exposure to fresh air. • Mobilization of Airway Secretions – Chest physiotherapy such as postural drainage – Mucolytics and inhaled hyperosmolar agents . regular exercise.

. – Macrolides . or airway hyperreactivity.Therapy (2) • Bronchodilator • Antibiotic . • Antiinflammatory – Corticosteroid .commonly for between 7 and 14 days. COPD.have significant effects on the mucociliary clearance mechanism through effects on ciliated airway epithelium and on mucus production and quality.indicated for use in patients with bronchiectasis for associated asthma.

which are nonresponsive to medical therapy. Localized resectable disease with failure to thrive. Resectable disease causing persistent focal infection. . 3. Localized disease causing severe symptoms. and 4. such as hemoptysis. 2.Surgery • Specific surgical indications include : 1. Life-threatening conditions.

many of whom have coexistent bronchiectasis.Prevention • Influenza vaccination .is widely recommended for use in both groups (child and adult) of patients. . in adults in particular because of a reduction in exacerbations in patients with COPD.

. and greater radiological extent of the disease appear to be most vulnerable. hypercapnia.Prognosis • Bronchiectasis morality appears to be up to 13% over a 5-year follow-up period and patients of older age with chronic hypoxia.

Complication • Microbial resistance to antibiotics. • Recurrent infections can result in injury to superficial mucosal vessels. with bleeding and. . life-threatening hemoptysis. in severe cases.


. Stephen L.• Charles Feldman. Aru W. Fauci. Hauser and Joseph Loscalzo. Buku Ajar Ilmu Penyakit Dalam. Bronchiectasis and Lung Abscess. Jakarta: Departemen Ilmu Penyakit Dalam. Bronkiektasis. Idrus Alwi. Marcellus Simadbrata K and Siti Setiati. Dennis L. p. 2007. Bronchiectasis: New Approaches to Diagnosis and Management. Bambang Setiyohasi. Principle Of Internal Medicine 18th ed. L. J. 2012 • Sudoyo. 10351039. In: pasiyan Rahmatullah. United State Of America: McGraw-Hill Companies. Dan. editor. Clin Chest Med 32 (2011) 535– 546 • Longo. Kasper. Anthony S. Larry Jameson.