6. Bronchiectasis

Bronchiectasis

• Bronchiectasis is defined as permanent dilatation and distortion of a portion of a bronchus due to structural weakness in the airway wall after chronic and recurrent infection and inflammation of airways.
• Destruction includes bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscles.
• Pathophysiology: Mucociliary clearance mechanism is impaired due to bronchial wall destruction, resulting in the accumulation of copious amounts of bronchial secretions. The small bronchi/bronchioles distal to the affected areas become partially or totally obstructed with secretions. This leads to hyperinflation of the distal alveoli, or atelectasis, consolidation, or fibrosis from complete bronchial obstruction.
• Etiology: Bronchiectasis can be either acquired or congenital.
  • Acquired: Recurrent Pulmonary Infections (TB, pneumonia, pertussis; Fungal; Allergic bronchopulmonary aspergillosis); Bronchial obstruction (foreign body, tumor); Inhalation and aspiration.
  • Congenital: Kartagener's syndrome (difficulty clearing mucus secretions); immunodeficiency; Cystic fibrosis (50%).
• Clinical findings of Bronchiectasis:
  • Objectives: State definitions, recognize pathophysiology, describe clinical findings in chest X-ray, describe available treatments.
  • Chest X-Ray Findings: Multiple ring opacities, most obvious at the lung bases, ranging from 3 to 15 mm in diameter; Overinflated lungs; Volume loss of the affected lobe, often with a depressed hilum; Vertical main stem bronchus; Left-sided transradiance; Diffuse complex pulmonary shadowing; dilated fluid-filled airways; Cylindrical or cystic, affecting the lower, or main lobe.
  • Vital Signs: Increased respiratory rate; Increased heart rate; Increased blood pressure; Increased cardiac output.
  • Inspection: Pursed lip breathing; Use of accessory muscles during inspiration and expiration; Venous distention; Barrel chest; Cyanosis; Digital clubbing; Peripheral edema.
  • Palpation: Decreased tactile fremitus.
  • Percussion: Hyporesonant on consolidation, hyperresonant in other areas.
  • Auscultation: Diminished breath sounds; Rhonchi; Wheezing.
  • Other Clinical findings: Cough, sputum production, hemoptysis. Chronic cough with large quantities of sputum is common.
• ABG Findings:
  • Mild to Moderate: pH: Increased; PaCO2: Decreased; HCO3: Decreased (slightly); PaO2: Decreased.
  • Chronic: pH: Normal; PaCO2: Increased; HCO3: Increased (significantly); PaO2: Decreased.
• Treatment:
  • Respiratory Care Treatments: Oxygen therapy; Bronchopulmonary hygiene therapy; Hyperinflation therapy; Aerosolized medication therapy (bronchodilators, steroids); Mechanical ventilation.
  • Other Treatments: Bronchodilators; Expectorants; Antibiotics; Hydration; Surgical resection (rare, severe cases); Lung transplant (rare, severe cases).

This quiz explores the definition, pathophysiology, and etiology of bronchiectasis. Learn about the causes of this condition, including both acquired and congenital factors. Test your understanding of the impact of bronchial wall destruction and its consequences on respiratory function.