Bronchiectasis

Definition
• Bronchiectasis is a chronic, irreversible dilation of the bronchi
and the bronchioles.

• It is the abnormal, permanent dilatation of one or more

bronchi with destruction of bronchial wall proximal to the
terminal bronchiole.
• Bronchiectasis is defined as permanent, abnormal dilatation of
one or more large bronchi.
Classification/Types
1. Saccular or cystic
2. Cylindrical
3. Fusiform
Etiology/Causes
1. Congenital
• Cystic fibrosis (hereditary disease that affects the lungs and
digestive system)
• Ciliary dysfunction syndromes (genetic condition in which the
microscopic organelles (cilia) in the respiratory system have
defective function.)
• Primary hypogammaglobulinaemia (problem with the
immune system that prevents it from making enough
antibodies called immunoglobulins)
Etiology/Causes
1. Acquired-children
• Pneumonia (complicating whooping cough or measles
• Primary TB
• Williams-Campbell syndrome (disease of the airways where
cartilage in the bronchi is defective.)
• Marfan’s syndrome (genetic disorder that affects the
connective tissue. Those with the condition tend to be tall and
thin, with long arms, legs, fingers, and toes.)
• Primary immunodeficiencies
• Inflammatory bowel disease, especially ulcerative colitis.
• Childhood Acquired Immune Deficiency Syndrome (AIDS),
• Inhaled foreign body
Etiology/Causes
1. Acquired-Adult
• Pneumonia
• allergic bronchopulmonary aspergillosis (severe allergic reaction
after being exposed to a type of fungus called Aspergillus)
• Pulmonary TB
• Infections caused by the staphylococcus, klebsiella
•  the causative agent of whooping cough
• various allergies all appear to be linked to the development of
Bronchiectasis
• alcoholism, heroin (drug use),
• Bronchial tumors
• hernia can cause Bronchiectasis when the stomach acid that is
aspirated into the lungs causes tissue damage.
Clinical Features
• The production of large quantities of purulent
and often foul-smelling sputum.
• The volume of sputum can be used for
estimating the severity of the disease
 Mild < 10 mL
 Moderate 10~150 mL
 Severe >150 mL
• Chronic cough
Clinical Features
• Hemoptysis: Frequent. Usually mild
(blood streaking of purulent sputum),
Massive hemoptysis is usually from dilated
bronchial arteries
• Recurrent pneumonia: same segment
• Systemic manifestations: fever, weight loss
• Chronic cough with foul smelling sputum
production,
Clinical Features
• Some people with bronchiectasis may produce
frequent green/yellow sputum (up to 240ml
daily).
• Pneumonia.
• Frequent bronchial infections and breathlessness
are two possible indicators.
• Dyspnoea,
• wheezing –
• COPD: Sputum volume increase
Investigation
• Chest x-ray
• Blood tests
• Checking oxygen levels in the blood
• Lung function tests
•  CT Scan
• Sputum culture: Testing of the mucus to identify
any bacteria present
• Bronchoscopy: Obstruction – foreign body,
tumor
Complications
• Haemoptysis, major pulmonary haemorrhage.
• COPD,
• Emphysema (the air sacs in the lungs (alveoli) are
damaged)
• Chronic respiratory insufficiency
• Recurrent pneumonia
• Lung abcess
• Hemoptysis
• Pulmonary hypertension
• Hypoproteinemia
• Generalized edema
Nursing Diagnosis
1.Ineffective airway clearance R/t
excessive secretions & weak cough.
2.Ineffective breathing pattern R/t
tachypnea. Activity intolerance R/t
decreased oxygen levels for metabolic
demands.
3.Deficient fluid volume R/t fever,
diaphoresis, & mouth breathing.
4.Imbalanced nutrition: less than
body requirements R/t
dyspnea.
5.Pain R/t frequent coughing.
Intervention
• Administer bronchodilators as prescribed.
• Administer antibiotics as prescribed.
• Inhalation is the preferred route
• Educate regarding types of indoor and outdoor air pollution
• Instruct and encourage patient in diaphragmatic breathing and
effective coughing.
• Adequately hydrate the patient.
• Use of diaphragmatic breathing and coughing techniques.
• Assist in administering nebulizer .
• Avoid bronchial irritants such as cigarette smoke,
• Teach early signs of infection : a. Increased sputum production
b.Change in color of sputum c. Increased thickness of sputum
d.Increased shortness of breath, tightness in chest, or fatigue e.
Increased coughing f. Fever or chills
• Administer antibiotics as prescribed.
Common Surgery
• Pneumonectomy (A pneumonectomy is a
surgical procedure to remove a lung.)
• Lobectomy (Lobectomy of the lung is a surgical
operation where a lobe of the lung is removed)
• Wedge resection (Wedge resection is a surgical
procedure to remove a triangle-shaped slice of
tissue)
• Sleeve lobectomy (Surgery to remove a lung
tumor in a lobe of the lung and a part of the
main bronchus (airway). )