Bronchiectasis, condition of lower respiratory tract

conditions of lower respiratory tract

1. BRONCHIECTASIS
Prepared by:
MUTEGEKI ADOLF
KSHS
131-Aug-24

3. Content
•Introduction
•Definition
•Risk factors
•Pathophysiology
•Clinical Features
•Diagnostic Evaluation
•Complications
•Management

4. Definition
•Bronchiectasisis a chronic lung condition characterized by the
abnormal and permanent widening (dilation) of the bronchi—the
large airways in the lungs—leading to impaired clearance of mucus
and frequent lung infections.
•Itinvolves irreversible dilation of the bronchi, resulting from the
destruction of the elastic and muscular components of the
bronchial walls.
•This condition leads to chronic cough, excessive sputum
production, and recurrent respiratory infections.

5. Types of bronchiectasis
•Cylindrical bronchiectasis
•Saccularbronchiectasis
•Varicose bronchiectasis

6. 1. Cylindrical bronchiectasis
•The bronchi are uniformly dilated and appear tube-like.
•The airways remain smooth and don't taper off as they
should towards the periphery of the lung.
•This is the most common and least severe form.
•Often caused by mild or reversible damage to the
airways, such as that resulting from lower respiratory
tract infections

7. 2. Saccular(Cystic) Bronchiectasis
•Most severe form of bronchiectasis. The bronchi are
severely dilated and the bronchi end blindly in a
dilated thick walled cyst.
•characterized by balloon-like sacs or cystic
spaces in the airways.
•The bronchi are markedly dilated, with large, sac-
like out pouching.

8. •Typically associated with the most severe
symptoms, frequent infections, and significant
airflow obstruction.
•This form represents advanced disease with
severe damage to the airway walls, and it often
leads to poor prognosis if not managed
aggressively

9. 3. Varicose Bronchiectasis
•The bronchi have an irregular or beaded appearance, with
alternating areas of dilation and constriction, resembling
varicose veins.
•This type is often seen in patients with more advanced disease
and represents more significant structural damage.
•It indicates more extensive destruction of the bronchial wall
and some degree of fibrosis

11. Risk factors
•Peoplewithcysticfibrosis
•Individualswithalpha-1anti-proteinase(alpha-1
antitrypsin)deficiencyoranembryologicaldefect
termedimmotileciliasyndrome
•Childrenthatdeveloplunginfectionswithlungtissue
destructionareriskforbronchiectasistodeveloplater
inlife
•Peoplethatabusedrugsandalcohol

12. •Peoplethathaverecurrentlunginfections,
aspirateforeignbodies,havehadahistory
oftuberculosisorinflammatorybowel
disease
•Individualsthatareexposedtotoxicgases
oranysubstancesthatdamagelungtissue.

13. Etiology
•LowBodyMassIndex
•Toxicfumes,gases,smokeandotherharmfulsubstances
•Immunodeficiency
•Connectivetissuediseases
•Exposuretochemicalirritants
•Rheumatoidarthritis
•Childhoodinfectionslikepneumonia,tuberculosis,measles,
whoopingcough
•Primarycilliarydyskinesia
•Exposuretochemicalirritants

14. Pathophysiology
•Bronchiectasis results from chronic inflammation or infection that
damages the bronchi walls. This damage leads to:
•Loss of CiliaryFunction: Impaired clearance of mucus from the
airways.
•Airway Dilation and Scarring: Structural changes, including
thickening and scarring of bronchial walls.
•Mucus Accumulation: The dilation allows for mucus to pool,
promoting bacterial growth and leading to recurrent infections.
•Vicious Cycle: Infections cause further inflammation, which
worsens airway damage and dilation, perpetuating a cycle of
infection and bronchial damage.

15. •Infection and inflammation damaging the bronchial wall
•Loss of CiliaryFunction
•Airway Dilation and Scarring
•Mucus Accumulation:
•Vicious Cycle: Infections cause further inflammation,
•A segment or lobe of lung collapse
•Bronchiectasis

17. Clinical manifestation
•Chronic Cough: Persistent cough, often productive with
large amounts of sputum.
•Recurrent Chest Infections: Frequent episodes of
bronchitis or pneumonia.
•Breathlessness: Shortness of breath or wheezing,
especially during exertion.
•Hemoptysis: Coughing up blood, especially in severe
cases.
•Fatigue: General tiredness and malaise.
•Crackles: Audible crackles or "rales" upon chest
auscultation

18. Diagnostic evaluation
•HistoryTaking
•Physicalexamination
•ChestCTscan:providesfurtherinformationondiseaselocation,
presenceofmediastinallesions,andtheextentofsegmental
involvement.
•Chestx-ray:increaseinsizeandlossofdefinitionofbronchovascular
markings,crowdingofbronchi,andlossoflungvolume.Severecase:
honeycombingappearance

19. •Pulmonary Function Tests (PFTs): Assess the
extent of lung function impairment.
•Sputum Cultures: Identify causative organisms
in recurrent infections.
•Blood Tests: Assess immune function or detect
underlying conditions (e.g., rheumatoid factor).
•Bronchoscopy: Direct visualization of the
airways to rule out foreign bodies, tumors, or
other abnormalities

20. Deferential Diagnosis
•Chronic Obstructive Pulmonary Disease (COPD)
•Asthma
•Pulmonary Tuberculosis (TB)
•Interstitial Lung Diseases (ILD)

21. Complications
•Pneumonia
•Lung abscess
•Empyema
•Septicemia
•Corpulmonale
•Metastaticcerebralabscesses
•Secondaryamyloidosiswithnephroticsyndrome
•Recurrentpleurisy
•Purulentpericarditis

22. MANAGEMENT
The goals of treatment are as follows:
1.Eliminate cause
2.Improve tracheobronchial clearance
3.Control infection
4.Reverse airflow obstruction

23. •Chestphysiotherapywithpercussion,posturaldrainage,
expectorantsorbronchoscopytoremovebronchial
secretions.
•Antimicrobialtherapyasguidedbysputumsensitivity
tests
•Bronchodilators,sympathomimetic(Beta-Adrenergic
Receptors)
•Posturaldrainage:Atechniqueusedtomobilizelarge
amountsofsecretionsinpeoplewithrespiratory
conditions.

25. Medications:
•Antibiotics: For treating acute infections or as
prophylaxis in some cases.
•Empiric coverage( amoxcilin, cotrimoxazole,
levofloxacin) is often given initially
•Pseudomonas-quinolone. Aminoglycoside, 3
rd
generation cephalosporin, pipracilin.
•Inhaled aerosolized aminoglycosides to prevent
pseudomonas colonization.

26. •Bronchodilators: To help open airways in cases of coexisting
airway disease.
•Mucolytics: Help break down mucus for easier clearance.e.g.
bromhexine. Mucine, erdosteine.
•Anti-Inflammatory Agents: In cases of coexistent airway
inflammation.
•Surgery: Rarely required, but may be considered for localized
disease not responding to other treatments.
•Vaccination: Annual influenza and pneumococcal vaccines.
•Management of Comorbidities: Treat any underlying
conditions that may contribute to disease progression

27. Supportive treatment:
•Smokingcessation
•Avoidanceofsecond-handsmoke
•Adequatenutritionalintakewithsupplementation,ifnecessary
•Immunizationsforinfluenzaandpneumococcalpneumonia
•Confirmationofimmunizationformeasles,rubellaand
pertussis
•Oxygentherapyisreservedforpatientswhoarehypoxemic
withseverediseaseandend-stagecomplications,suchas
corpulmonale.

28. Surgical management
•Segmental resection(segment of a lobe)
•Lobectomy (removal of lung lobe)
•Pneumonectomy(removal of the entire lung)

30. Prevention
•Prompt Treatment of Infections: Early and effective treatment of
respiratory infections to prevent bronchial damage.
•Vaccinations: Prevent respiratory infections with vaccines against
influenza, pneumonia, and whooping cough.
•Smoking Cessation: Avoid tobacco smoke and other
environmental pollutants.
•Avoid Aspiration: Careful eating practices and managing
conditions that increase the risk of aspiration.
•Genetic Counseling: For those with a family history of
bronchiectasis due to genetic disorders.

31. References
•MandalG.N.,textbookofmedicalsurgicalnursingpublishedby
makalupublicationhouse,3
rd
edition,pageno:92-93
•https://www.google.com/search/Client=firefox-b-d=bronchictasis
@2021/07/12
•Nov2,2019.
Bronchiectasishttps//www.slideshare.net@Gamandeep2021/07/10at
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