BRONCHIECTASIS

• Definition
• Pathophysiology
• Sign and symptoms
• Clinical feature
• Medical treatment
 DEFINITION

 Bronchiectasis is defined as
abnormal and irreversible
dilatation of the bronchi and
bronchioles (greater than
2mm in diameter) developing
secondary to inflammatory
weakening of bronchial walls.
PATHOPHYSIOLOGY
 bronchial dilatation is associated with
destructive and inflammatory changes in
the walls of medium-sized airways, often at
the level of segmental or subsegmental
bronchi
 Airway inflammation is primarily mediated
by neutrophils and results in up-regulation
of enzymes such as elastase and matrix
metalloproteinases
 The normal structural components of the wall,
including cartilage, muscle, and elastic tissue,
are destroyed and may be replaced by fibrous
tissue
SIGN AND SYMPTOMS
 Symptoms of bronchiectasis can take months or even years to
develop. Some symptoms are:
 chronic coughing
 coughing up blood
 abnormal sounds or wheezing in the chest on breathing
 shortness of breath
 chest pain
 coughing up large amounts of mucus daily
 bad breath odor
 skin with a blue appearance
 weight loss
 fatigue
 thickening of the skin under your nails and toes
CLINICAL FEATURE

 Patients typically present with persistent or recurrent cough

and purulent sputum production
 Hemoptysis occurs in 50–70% of cases
 Massive bleeding is often a consequence of bleeding from
hypertrophied bronchial arteries
 Systemic symptoms such as fatigue, weight loss, and
myalgias can also occur
 When a specific infectious episode initiates bronchiectasis,
patients may describe a severe pneumonia followed by
chronic cough and sputum production
 patients without a dramatic initiating event often describe
the insidious onset of symptoms
 some cases are either asymptomatic or have a nonproductive
cough (dry bronchiectasis).
 Dyspnea or wheezing generally reflects either widespread
 CLINICAL FEATURES

CHILDREN:
 General health is poor
 Recurrent infections
 Loss of appetite
 Clubbing of fingers
 Cough with copious mucopurulent expectoration
(younger children may not expectorate since they
tend to swallow the sputum)
 Hemoptysis may ooccur.
TREATMENT

 Therapy has several major goals:

(1) treatment of infection, particularly during acute
exacerbations (2) improved clearance
tracheobronchial secretions
(3) reduction of inflammation
(4) treatment of an identifiable underlying problem
Antibiotics are the cornerstone of bronchiectasis
management
 antibiotics are used only during acute episodes
 There are no firm guidelines for length of therapy, but
10–14 day course or longer is typically administered
Facilitate drainage : mechanical methods and dev
& appropriate positioning
 Bronchodilators to improve obstruction and aid cleara
 TREATMENT

In children
The airway should be kept clear of secretions :
effective cough and postural drainage
Surgical resection : in children who have marked
symptoms and disease is localized
Extrinsic compression of bronchi requires surgical
intervention
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