BRONCHIETASIS

Abnormal and permanent “Dilatation of the bronchi” due to the irreversible destruction of bronchial walls

Bronchiectasis is reversible when it results from severe bronchitis, acute pneumonia and allergic bronchopulmonary aspergillosis

PATHOLOGY

•Bronchiectasis most commonly occurs in lower lung fields

•Distal bronchial segments are involved in most cases of bronchiectasis

•Proximal in ABPA

•2nd to 4th order bronchi are involved

•Disease in bilateral in 30 % cases

PATHOGENSIS

Consequence of inflammation and destruction of the structural components of the bronchial wall

CAUSES AND ASSOCIATIONS OF BRONCHIETASIS

•Infections

•Adenoviral and / or bacterial

•Measles, influenza, or pertussis in childhood

•Tuberculosis (upper lobes)

•Chronic histoplasmosis

•Coccidiodomycosis

•Klebsiella, staph aureus, anaerobes (Preantibiotic era)

HIV (AIDS)

CILIARY DYSKINESIA SYNDROME

(IMMOTILE CILIA)

(Kartagener’s syndrome)

Hypogammaglobulinemia

•Congenital (or bruton’s x-linked

agammaglobulinemia

H.influenzae, S.aureus, S.pneumonia

•Acquired agammaylobulinemia (Common variable immune deficiency)

•Sinopulmonary infections (2nd or 3rd decade)

•Selective IgA deficiency

•Hyperimmunoglobulinamma E (Job’s syn)

S.aureus, S.pnemoniae, gram negative bacilli, candida albicans, aspergillus

•Right middle lobe syndrome

•Allergic bronchopulmonary aspergillosis

•Yellow nail syndrome

•Obstructive azoospermia (Young’s syndrome)

•Unilateral hyperlucent lung syndrome (swyer –James or Maeleod syndrome

MISCELLANEOUS

•alpha1- antitrypsin phenotype

•Rhematoid Arthritis (felty’s syndrome)

•Toxic chemicals

•Recurrent aspiration

•Heroin

•Inflammatory bowel disease

•Foreign body

•Sequestrated lung

•Relapsing polychondritis

•Chronic tracheoesophageal fistula

•Heart lung transplantation

•Chronic granulomatons disease of childhood

•Postobstructive (tumors, long standing foreign body, stenosis, etc)

INVESTIGATIONS

•Chest x-ray

•High-resolution CT Scanning

•Bronchography

•Sputum – Gramstain culture & sensitivity

•Sinus x-ray

•Serum immunogiobulins

•Sweat electrolytes

•Mucociliary clearance

TREATMENT

Goals 4 major goals

•Elimination of an identifiable under lung problem

•Improved clearance of tracheobronchial secretions

•Control of infection, particularly during acute exacerbation

•Reversal of airflow obstruction

TREATMENT

•Postural drainage

•Antibiotics

•Bronchodilators

•Anti inflammatory agents

•Inhaled or oral steroids

•Surgery

COMPLICATIONS

•Hemoptysis (50% Patients)

•Progressive respiratory failure with hypoxemia

•Corpulmonale

•Secondary infections by fungi and noninfectious mycobacteria

•Pneumothorax

•Empyema

•Metastatic cerebral abscess