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DEFINISION
Bronchiectasis is a condition that is characterized by the permanent dilatation of
the bronchi associated with destruction of elastic and muscular components of their walls,
usually due to chronic infection.
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CLINICAL MANIFESTATIONS
a. Cough and sputum:
Patients complains of persistent cough with purulent sputum since childhood.
Initially, it is present only following colds or influenza, but if the disease is allowed to
progress in severity the effected segments continually accumulate purulent secretions,
resulting in cough and sputum production. The sputum is usually in green, often foulsmelling and present fairly large volume.
The cough is particularly troublesome on a change of position and on raising
first thing in the morning.
b. Dyspnoea:
Shortness of breath is noticeable only if disease is particularly severe and
widespread. If the bronchiectasis is localized, other well-ventilated and perfused alveoli
should maintain blood gases at a reasonable level, although bronchospasm may be a
Feature, particularly during an exacerbation.
c. Haemoptysis:
This occurs quite commonly, usually in association with an acute infection. It can
be life-threatening if severe and may require surgical resection of the affected lung tissue.
d. General ill-health:
Patients may suffer pyrexia, night sweats, anorexia, malaise, weight loss, lassitude
and oint pains.
e. Clubbing:
In about 50per cent of patients fingers and toes become clubbed. The first sign of
clubbing is loss of the angle between the nail and the nail bed. This is followed by
curvature of the nail, and an increase in the soft tissue of the ends of the fingers, forming
so- called drumstick fingers.
f. Thoracic Mobility
This gradually decreases, as do shoulder girdle movements.
TYPES OF BRONCHIECTAISIS:
Types of bronchiectasis include:
1-Cylindric/Fusiform/Tubular:
Cylindrical
bronchiectasis
produces
"tram-lines"
because the distal bronchus has the same lumen size as parent and extends to the lung
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periphery. This is the most common form of bronchiectasis. It may occur secondary to
infection, ciliary dyskinesia, or cystic fibrosis. Patients may have only mild symptoms
such as a cough, with small amounts of sputum production. On HRCT there are thick
walled (smooth, not irregular) bronchi which extend into the peripheral 3 cm of the lung.
2- Saccular/Cystic: This is the most severe form of bronchiectasis. It is characterized by
progressive dilatation of the bronchi toward the periphery which terminate in cytic
cavities resembling balloons. The findings may resemble a cluster of cysts. Air-fluid
levels within the massively dilated bronchi are seen frequently due to retained secretions,
and are usually not seen in uncomplicated lung cysts. Remember, that in contrast to
bronchiectasis, emphysematous bullae have no discernible walls.
3. Traction/ Varicose: Unlike most other causes of bronchiectasis, the airway changes
are not caused by a primary insult to the airways themselves, but rather as a result of
adjacent parenchymal fibrosis. In this form of bronchiectasis the bronchial walls are
characteristically more irregular and may assume a beaded appearance when in the plane
of section (resembling a "varicose" vein). Differentiation from cylindrical bronchiectasis
is difficult when viewed in cross section.
Varicose bronchiectasis with alternating areas of bronchial dilatation and constriction.
AETIOLOGY
Bronchiectasis is caused by recurrent inflammation or infection of the airways. It
may be present at birth, but most often begins in childhood as a complication from
infection or inhaling a foreign object. Prior to the widespread use of immunizations,
bronchiectasis was often the result of a serious infection with either measles or whooping
cough. Now, viruses that cause influenza (flu) or influenza-like syndromes, may lead to
development of bronchiectasis.
Some other Causes of Bronchiectasis may be:
Some rare immune problems can also cause lung infections and
damage to airways thereby causing bronchiectasis.
It is also seen in later life after severe lung infections such as pneumonia
in childhood, and it is sometimes
INVESTIGATIONS
Diagnostic Tests and Procedures:
a. Chest Computed Tomography Scan:
The most commonly used test to diagnose bronchiectasis is a chest computed
tomography scan, or chest CT scan. This painless test creates precise images of your
airways and other structures in your chest. It can show how much your airways are
damaged and where the damage is. A chest CT scan gives more detailed pictures than a
regular chest x ray.
This CT scan shows areas of both cystic bronchiectasis and varicose bronchiectasis.
b. Chest X Ray:
You also may have a chest x ray. This painless test creates pictures of the
structures in your chest, such as your heart and lungs. A chest x ray may show areas of
abnormal lung and thickened, irregular airway walls.
Cystic and cylindrical bronchiectasis of the right lower lobe on a posterior-anterior chest
radiograph.
c. Other Tests:
You also may have other tests, such as:
Blood tests: These tests can show whether you have an underlying condition that
can lead to bronchiectasis. They also can show whether you have an infection or
low levels of certain infection-fighting blood cells.
A sputum culture: Lab tests of a sample of your sputum can show whether you
have bacteria (such as the bacteria that cause tuberculosis) and fungi.
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Lung function tests: These tests measure the size of lungs, how much air you can
breathe in and out, how fast you can breathe air out, and how well your lungs
deliver oxygen to your blood. Lung function tests help show how much lung
damage you have.
d. Bronchoscopy:
If bronchiectasis doesn't respond to treatment, Bronchoscopy is a procedure used
to look at the insides of the airways.
During this procedure, a long, narrow, flexible tube with a light on the end is
inserted through your nose or mouth into your airways. This tube is called a
bronchoscope. It provides a video image of your airways. You'll be given medicines to
numb the upper airway and to help you relax during the procedure.
Bronchoscopy can show whether something is blocking your airways. If there is
bleeding, this procedure can show where the bleeding is coming from.
Ciliary function test:
A screening test can be performed in patients suspected of having a cilary dysfunction
syndrome by assessing the time taken for a small pellet of saccharin placed in the anterior
chamber of nose to reach pharynx, when the patient can taste it. This time should not
exceed 20minutes and is greatly prolonged in patients with ciliary dysfunction.
It is also possible to assess ciliary function by measuring ciliary beat frequency using
biopsies taken from nose.
If ciliary function is thought to be impaired, the ciliary ultrastructure should also be
determined by electron microscopy.
MANAGEMENT
A. Conservative Management
Antibiotics and chest physiotherapy are the mainstay modalities. Other modalities
(beyond those for specific associated conditions) may include bronchodilators,
corticosteroid therapy, dietary supplementation
Bronchodilator therapy is as follows:
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a. Bronchodilators, including
- Beta-agonists and anti-cholinergic- may help some patients with bronchiectasis,
presumably reversing bronchospasm associated with airway hyperreactivity and
improving mucociliary clearance.
- Treatment with inhaled bronchodilators may be appropriate.
b. Anti-inflammatory medication therapy is as follows:
The rationale is to modify the inflammatory response caused by the
microorganisms associated with bronchiectasis and subsequently reduce the amount of
tissue damage.
B. SURGICAL MANAGEMENT:
Surgery is an important adjunct to therapy in some patients with advanced or
complicated disease. Surgical resection for bronchiectasis can be performed with
acceptable morbidity and mortality in patients of any age. In general, surgery should be
reserved for patients who have focal disease that is poorly controlled by antibiotics.
The involved bronchiectatic sites should be completely resected for optimal symptom
control.
a. Postural Drainage and Chest Physiotherapy:
Postural drainage therapy (PDT) is a component of bronchial hygiene
therapy. It consists of postural drainage, positioning, and turning and is sometimes
accompanied by chest percussion and/or vibration.
Cough or airway clearance techniques are essential components of therapy
when postural drainage is intended to mobilize secretions. Postural drainage
therapy is often used in conjunction with aerosol administration and other
respiratory care procedures.
Chest physiotherapy,
Avoiding toxic fumes, gases, smoke, and injurious dusts also helps
prevent bronchiectasis or reduce its severity.
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CONCLUSION
According to the treatment i have conclude that prevention is always better than
cure. Hence the patient is advice to stop smoking, if he is chronic smoker. Patient is also
advice to take care of personal and environment hygine, health and good diet.
Physiotherapist has main role in treating the bronchiectasis patients, to prevent the
condition becoming worse.
The patient is given chest physiotherapy in the early stages itself to improve
the condition. Chest physiotherapy techniques include breath exercises, coughing,
huffing, manual techniques, postural drainage, mobility exercises, relaxation positions
ect.
Hence physiotherapy plays a major role in bringing out a good prognosis.
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