BRONCHIECTA

SIS

OUTLINE

Definition

Causes

Clinical Manifestation

Workup

Management

BRONCHIECTASIS IS

Chronic necrotizing infection of the bronchi and bronchioles leading to abnormal, permanent dilatation of the airways

EPIDEMIOLOGY

Prevalence unknown due to the lack of observational studies in the population but vary substantially based on country

Common trends: The prevalence of bronchiectasis increases with age Bronchiectasis is more common in women Patients with bronchiectasis use extensive healthcare resources

(frequent admissions, antibiotics usage, HRCT etc)

PATHOPHSYIOLOGY

Requires two factors for the induction of bronchiectasis An infectious insult Impaired drainage, airway obstruction, or a defect in host defense

Abnormal wall dilatation, destruction and transmural inflammation

CAUSES

Respiratory Infections Pertussis Measles Tuberculosis Severe bacterial pneumonia

Bronchial Obstruction Foreign Body Chronic Aspiration Endobronchial Tumor Lymph nodes (TB, sarcoidosis, and malignancy) Granulomata (TB, sarcoidosis and malignancy)

CAUSES

Fibrosis Long standing pulmonary fibrosis Fibrosis complicating TB and sarcoidosis Fibrosis complicating unresolved or suppurative pneumonia

Muco-ciliary clearance defects Cystic Fibrosis Immotile Cilia syndrome Kartagener syndrome Young syndrome

CAUSES

Immunodeficiency Congenital and acquired hypogammaglobulinemia AIDS

Allergic Bronchopulmonary Aspergillosis

Autoimmune Disease Rhematoid Arthritis Sjogren Syndrome IBD

CLINICAL MANIFESTATION

Symptoms Cough with thick mucoid sputum Dyspnea Chest pain Fever

CLINICAL MANIFESTATIONS

Signs Clubbing Coarse Crepitations which alters with coughing Inspiratory clicks Rhonchi Signs of cor pulmonale

IX WORKUP

FBC

Sputum C+S

Immunoglobulin quantitation

Mutation analysis of the cystic fibrosis transmembrane conductance regulator (CFTR) gene

IMAGING

CXR

HRCT

MANAGEMENT

General Measures Stop smoking Adequate nutritional intake and supplementation if necessary Immunizations for influenza and pneumococcal pneumonia LTOT

MANAGEMENT (CONT.)

Physiotherapy and postural drainage

Antibiotics Empirical. BTS recommends 14 day course If previous sputum C+S results were known, can be used to guide

current exacerbation

Bronchodilator Therapy

Anti Inflammatory Medications

MANAGEMENT (CONT.)

Surgery Surgical resection for localised bronchiectasis (poorly controlled by

antibiotics) Bronchial artery embolization for massive hemoptysis Foreign body or tumour removal Lung transplamnt in patients with Cystic Fibrosis