Bronchiectasis Lecture Notes - Jabir ibn Hayyan University

BRONCHIECTASIS Dr: Husseein Fadhil Abd zaid Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences ١  OBJECTIVES AFTER COMPLETING THIS LECTURE, ATTENDANCE WOULD BE ABLE TO:- 1-Define the bro...

BRONCHIECTASIS Dr: Husseein Fadhil Abd zaid Jabir Ibn Hayyan University for Medical and Pharmaceutical Sciences ١  OBJECTIVES AFTER COMPLETING THIS LECTURE, ATTENDANCE WOULD BE ABLE TO:- 1-Define the bronchiectasis. 2- Numerate the causes of bronchiectasis. 3- Identify clinical features of bronchiectasis. 4- Diagnose the bronchiectasis. 5- Treat the bronchiectasis. ٢ ٣  DEFINITION bronchi & bronchioles normally become narrower as they go distally. if they maintain the same caliber or dilate as they go distally, the condition is called bronchiectasis. BRONCHIECTASIS is a chronic obstructive suppurative airway disease associated with abnormal irreversible enlargement of the airways due to destruction of airway architecture. ٤ ٥ ٦  CAUSES in many cases of bronchiectasis, an underlying cause is not identified. common causes of bronchiectasis ❑lnfection-related ▪Tuberculosis :is the most common cause. ▪nontuberculous mycobacteria ▪pneumonia, especially recurrent and (Whooping cough or Measles). ٧  CAUSES ❑ airway obstruction: localized bronchiectasis occurs beyond an obstruction ▪Tumor ▪Enlarged hilar lymph nodes. ▪foreign body ❑ Lmmunodeficiency ▪common variable immunode{iciency ▪primary hypogammaglobulinaemia ▪HIV ❑ Hypersensitivity ▪allergic bronchopulmonary aspergillosis ٨  CAUSES ❑ Autoimmune disorders ▪ rheumatoid arthritis sjogren's syndrome lnflammatory bowel disease ❑ Mucociliary dysfunction ❑ cystic fibrosis ❑ primary ciliary dyskinesia ❑ young syndrome ( bronchiectasis, sinusitis, and obstructive azoospermia and no evidence of cystic fibrosis) ٩  CAUSES ❑congenital ▪ cystic fibrosis ▪ ciliary dysfunction syndromes: ▪ primary ciliary dyskinesia (immotile cilia syndrome) ▪ kartagener syndrome (sinusitis and transposition of the viscera) ▪ primary hypogammaglobulinaemia ١٠  CLINICAL PICTURE SYMPTOMS OF BRONCHIECTASIS  Cough: chronic, daily, persistent  Sputum: copious (> 100 ml/D), continuously purulent  Pleuritic pain: when infection spreads to involve pleura, or with segmental collapse due to retained secretions  Dyspnea. ١١  CLINICAL PICTURE  Haemoptysis streaks of blood common, larger volumes with exacerbations of infection massive haemoptysis requiring bronchial artery embolisation sometimes occurs  Infective exacerbation: increased sputum volume with fever, malaise, anorexia  Halitosis: frequently accompanies purulent sputum  General debility: dificulty maintaining weight, anorexia, exertional breathlessness ١٢  Signs ❖clubbing of fingers ❖coarse inspiratory & expiratory crepitation which change after asked to cough. (the cause of crepitation is the passage of air in bronchus filled with mucous). ❖Wheezing ❖advanced disease may cause scarring and overlying bronchial breathing ١٣  INVESTIGATIONS CXR may show:-Mild bronchiectasis may not be apparent on a plain chest X-ray. ✓ Ring shadows and Tramlines (indicating thick-airways). ✓ Honey-comb appearance (late) Bronchoscopy:- help to detect site of hemoptysis & to identify underlying cause PFT: Obstructive pattern with incomplete reversibility (as COPD). ١٤  INVESTIGATIONS bronchiectasis is diagnosed by high resolution chest CT scan. diagnostic criteria include: an airway diameter that is greater than that of its accompanying vessel and lack of distal airway tapering.Bronchial wall thickening or cysts may be present. Sputum culture may reveal pseudomonas aeruginosa and staphylococcus aureus, fungi such as aspergillus and non-tuberculous mycobacteria ١٥ ١٦  INVESTIGATIONS Sputum microbiology (including for atypical organisms: acid- fast bacilli & Aspergillus). Immunoglobulin levels. If the patient is suspected of having a ciliary dysfunction syndrome nasal FeNO sample should be taken as a screening test, then consideration of nasal brush biopsy and genetic testing. connective tissue disease and immune function like immunoglobulin level. ١٧  INVESTIGATIONS However, even with advanced evaluation, more than half of all cases are labeled idiopathic. ١٨  QUICK QUIZ Scan the QR code or enter the mentimeter class code HTTPS://WWW.MENTI.COM/ALABF4OMANK4 ١٩  TREATMENT IS BRONCHIACTASIS is treatable? ٢٠  TREATMENT Irreversible airway dilation. Therefore, treatment of the underlying cause may not lead to improvement in current symptoms but ✓ could prevent further progression. otherwise. treatment of bronchiectasis focuses on : ✓the clearing the airway ✓treating infections, and ✓ preventing exacerbations. ٢١  TREATMENT ✓ Physiotherapy (Postural drainage) (5-10 min) once or twice-daily to keep the dilated bronchi empty of secretions. regular daily physiotherapy to assist the drainage of excess bronchial secretions, Deep breathing, followed by forced expiratory manoeuvres (the ‘active cycle of breathing’ technique). ✓ Bronchodilator for obstruction. ✓ Antibiotics for infections. Most common organisms isolated from patients with bronchiectasis: ✓ · Haemophilus influenzae (most common) ✓ · Pseudomonas aeruginosa ✓ · Klebsiella spp. ✓ · Streptococcus pneumoniae ٢٢ TREATMENT.Mucolytic for thick sputum ✓ Surgery: considered if bronchiectasis is unilateral ✓.& confined to a single lobe Vaccines: Influenza vaccine annually and Pneumococcal vaccine & patient should stop smoking ٢٣  COMPLICATION 1. Respiratory failure. 2. Recurrent infection. 3. Pulmnary hypertension Cor-pulmonale. 4. pneumothorax. 5. Brain abscess. 6. Amyloidosis (AA type) resulting in nephrotic syndrome ٢٤ ٢٥ Please fill the poll bellow for feedback https://www.menti.com/alabf4omank4 ٢٦ ٢٧