 This young man has

long history of
productive cough and
wheezing. He is
afebrile and chest
auscultation reveals
coarse crackles at
right lower chest
BRONCHIECTASIS


 Bronciectasis (Greek word)

•Bronkos ---- Wind pipe

•Ektesis ---- Stretching
HOW DO YOU DEFINE BRONCHIECTASIS ?
 BRONCHIECTASIS
Abnormal and permanent
dilatation of bronchi and
bronchioles greater than 2 mm
 CLASSIFICATION
REID’S CLASSIFICATION (1950)

• Based on Pathology & Bronchography

 Cylindrical
 Varicose

 Saccular (Cystic)
Sacular type Cylindrical
Varicose Type
MUCOUS PLUGS

DILATED
BRONCHIOLE
PATHOGENESIS
NORMAL HOST RESPONSE TO
BRONCHIAL INSULT

BRONCHIAL INSULT

INFLAMMATION
RETURN TO HEALTH

MUCOCILLIARY CLEARENCE
ABNORMAL HOST RESPONSE TO
BRONCHIAL INSULT
BRONCHIAL INSULT

BRONCHIECTASIS INFLAMMATION

BRONCHIAL DAMAGE IMPAIRED MUCOCILLIARY

CLEARENCE

FURTHER INFLAMMATION BRONCHIAL OBSTRUCTION

 PATHOGENESIS
 OBSTRUCTION
 INFLAMMATION
ETIOLOGY OF
BRONCHIECTASIS

Congenital
Acquired
 Case Study
 While doing clinical elective in UK,
you happen to see a young man,
who has been regularly visiting chest
clinic since birth with multiple
admissions. He c/o productive cough
and shortness of breath. His brother
also suffers from the same disease.
His chest x-ray is
 What is the
diagnosis ?
 What is mode of
inheritance ?
 What do you see
on this chest x-ray.
 What is pathology
CYSTIC FIBROSIS

 What is the
diagnosis ?
 What is mode of
inheritance ?
 What do you see
on this chest x-ray.
 What is pathology
 Case Study

30 Years old gentleman comes to you

with chronic sinusitis and productive
cough. His x-ray of sinuses and chest
are
What is the diagnosis ?
Kartageyner Syndrome
 Primary ciliary dyskinesia (PCD)
or Kartagener Syndrome (KS), is a
rare, ciliopathic, autosomal recessive gene
tic disorder that causes a defect in the
action of the cilia lining the respiratory
tract (lower and pper, sinuses, Eustachian
tube,middle ear) and fallopian tube.
 Kartageyner Syndrome
 It is combination of Ciliary
Dyskinesia and situs inversus
(complete or incomplete)
 Infertility
What are the congenital causes
of Bronchiectasis ?
 ETIOLOGY: CONGENITAL

 Cystic Fibrosis
 Primary Ciliary Dyskinesia
 Kartagener’s Syndrome
 Immunodeficiency States
 Intralobular Lung Sequestration
 AQUIRED CAUSES
 POST INFECTIOUS
 BRONCHIAL OBSTRUCTION
 MISCELLANEOUS CONDITIONS
 AQUIRED CAUSES
POST INFECTIOUS
 Bacterial
 Mycobacterium tuberculosis
 Pseudomonas aureginosa
 Hemophillus influenzae
 Staphylococcus aureus
 AQUIRED CAUSES:
POSTINFECTIOUS
 Viral
 Adenovirus
 Influenza

 HIV

 Fungal
 Aspergillus fumigatus (ABPA)
 Allergic Bronchopulmonary
Aspergillosis (ABPA)
 Mainly in
Asthmatics
 Sensitization to
aspergillous
 Raised IgE level
 Tubular
Bronchiectasis
 ETIOLOGY : BRONCHIAL
OBSTRUCTION
 Tumour
 Foreign Bodies
 Mucous Plugs
 ETIOLOGY: OTHER CAUSES

 Rheumatoid Arthritis
 Inflammatory Bowel Disease
 Systemic Lupus Erythematosus
 Post transplant
 CLINICAL PRESENTATION
 SYMPTOMS
 Persistent cough
 Purulent sputum
(green and foul smelling)
 Hemoptysis WET TYPE
 Dyspnea
 Wheeze
 Fever
 Severe Pneumonia
 Asymptomatic DRY TYPE
 Non Productive Cough
 CLINICAL PRESENTATI0N
 SIGNS
• On GPE
 Digital Clubbing
 Cyanosis
 Plethora
 Muscle wasting
• On Auscultation
 Crackles
 Wheeze
 Ronchi
 COMPLICATIONS
 Recurrent pneumonia
 Empyema
 Haemoptysis
 Pneumothorax
 Lung abscess
 Brain abscess
 Amyloidosis
 Cor pulmonale
 DIAGNOSIS
 CLINICAL PRESENTATION
 SPUTUM ANALYSIS
 RADIOLOGY
 DIRECT VISUALISATION
 ESTABLISHMENT OF CAUSE
 CLINICAL PRESENTATION

 HISTORY
 CLINICAL EXAMINATION
 RULE OUT
 Pneumonia
 Emphysema
 Lung abscess
 SPUTUM ANALYSIS
 Amount of sputum
 24 hr Sputum Production
 Mild < 10 ml/day
 Moderate <150 ml/day
 Severe >150 ml/day
 Visual Impression
 Microbiology
 Streptococcus pneumoneae
 Hemophillus influenzae
 Aspergillus
 Psedomonas
 E. coli
 LAB TESTS
 Blood complete picture
 Quantitative immunoglobulin
 Alpha-1 anti-trypsin level
 RADIOLOGY
 Chest X-ray PA view
 Cylindrical
 Varicose
 Saccular
 Bronchography
 CT Scan
 DIRECT VISUALISATION
 Bronchoscoy

 Flexible

 Rigid
 ESTABLISHMENT OF CAUSE
 Serum Protein electrophoresis
 Serum Immunoglobulins
 Pilocarpine Iontophoresis (Sweat Test)
 Aspergillus Precipitin Test
 Electron Microscopy
 MANAGEMENT

 4 GOALS
 Elimination of Problem
 Clear Tracheo-bronchial Secretions
 Control Infections
 Reverse Airflow Obstruction
 MANAGEMENT
 POSTURAL DRAINAGE
 BRONCHODIALATORS
 CORTICOSTEROIDS
 TREAT INFECTIONS

 Antibiotics (according to C&S)

 Amoxicillin 250mg -------- TDS
 Co-amoxiclav 325mg -------- TDS
 Levofloxacin 500mg -------- BD
 Ceftazidime
 Preventive and suppressive
antibiotics
 Other treatment

 Inhaled Broncho dilators

 Inhaled aerosolized aminoglycosides
 Surgery
 Reserved for patients with localised
bronchiectasis and adequate lung
functions
 Sometime in massive haemoptysis
 PREVENTION
 VACCINATION
 Influenza vaccine
 Pneumococcal vaccine

 AVOID EXACERBATING FACTORS

 Regular chest physiotherapy