Respiratory Medicine Bronchiectasis PDF

Respiratory Medicine Obstructive Lung disease Airway diseases BRONCHIECTASIS 19/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Pulmonary medicine  LECTURE CONTENTS  CASE SCENARIO  INTRODUCTION OF BRONCHIECTASIS  EPI...

Respiratory Medicine Obstructive Lung disease Airway diseases BRONCHIECTASIS 19/10/2024 Dr. Mahad Sadik Mukhtar Pulmonologist MD Pulmonary medicine  LECTURE CONTENTS  CASE SCENARIO  INTRODUCTION OF BRONCHIECTASIS  EPIDEMIOLOGY  TYPES OF BRONCHIECTASIS  CAUSES OF BRONCHIECTASIS  PATHOPHYSIOLOGY  CLINICAL FEATURES  DIAGNOSIS OF BRONCHIECTASIS  MANAGEMENT OF BRONCHIECTASIS  PREVENTIONS OF BRONCHIECTASIS  SUMMARY  CASE SCENARIO  A 55-year-old woman presents for evaluation of a chronic cough, productive of thick, yellow sputum that sometimes becomes blood- tinged.  She has experienced recurrent episodes of fever associated with pleuritic chest pain.  She states that she is embarrassed by the persistent, intractable nature of her cough and has been prescribed multiple courses of antibiotics.  Over the last 5 years, she has developed shortness of breath with exertion.  Her past medical history is significant for pneumonia as a child and sinus polyps during  INTRODUCTION Bronchiectasis describes abnormal and permanently dilated airways. The disease is characterized by a vicious circle of neutrophilic inflammation, recurrent infection and damage to the airway. further impairs mucociliary clearance, and persistent inflammation leads to impairment of immunity  INTRODUCTION Bronchiectasis is associated with a number of diseases but a cause will only be found in around 50% of cases. Little is known about the epidemiology and there is a wide variation in reported incidence. Bronchiectasis related to cystic fibrosis.  EPIDEMIOLOGY The prevalence worldwide is unknown due to the lack of standardised medical care and poor health care access in underdeveloped countries. In the UK, an estimated 212,000 individuals are affected. In the US, an estimated 110,000 individuals are affected, but data suggest that prevalence is increasing.  Global statistics suggest that the incidence of bronchiectasis has risen over the past few years.  It can exist in any age group.  Bronchiectasis is responsible for the significant loss of lung function and one that can result in considerable morbidity and even early mortality. Remember, as long as you are breathing it’s never too late to start a new beginning.  EPIDEMIOLOGY Bronchiectasis is more common with advancing age, ranging from 4.2 per 100,000 people aged 18 to 34 years to 272 per 100,000 people over 75 years old. The economic burden of bronchiectasis is significant, with hospitalisations being the main driver, particularly in patients with frequent exacerbations or chronic Pseudomonas infection.  Continue…. More than 60% of adults with bronchiectasis report symptoms from childhood, and these patients have worse disease and a poorer prognosis compared with patients with adult onset bronchiectasis. Bronchiectasis is associated with a poor quality of life in both children and their parents, particularly when exacerbations are frequent. TYPES OF BRONCHIECTASIS  CAUSES OF BRONCHIECTASIS Continue……  PATHOPHYSIOLOGY The three most important mechanisms that contribute to the pathogenesis of bronchiectasis are recurrent infections, airway obstruction, and peribronchial fibrosis. Neutrophils dominate airway inflammation in bronchiectasis, driven by high concentrations of neutrophil chemoattractants such as interleukin-8 (CXCL-8), and leukotriene B4.  Continue……….. Airway bacterial colonization occurs because of impaired mucociliary clearance and because of the failure of neutrophil opsonophagocytic killing. Continue………. CLINICAL FEATURES CLINICAL FEATURES  DIAGNOSIS  History taking  Physical Exam  İnvestigations  Laboratory tests are geared towards identifying the underlying aetiology, as treatment will be successful only if it treats both the bronchiectasis and any underlying disease process.  Certain tests are only available in specialised centres. DIAGNOSIS  In children and adolescents, changes in chest auscultation are important but should not be relied upon as they are not always present. INVESTIGATIONS CHEST-XRAY IMAGING MANAGEMENT OF BRONCHIECTASIS Continue…………. PREVENTIONS