Bronchiectasis

Question 1

Definition of Bronchiectasis

Answer 1

Abnormal, irreversible dilatation of bronchi caused by destructive and inflammatory changes in airway walls, associated with infection

Question 2

Etiology of Bronchiectasis

Answer 2

One or both lungs involved

Found generally in lower lobes (smaller bronchi tend to be most affected)

Commonly limited to a lobe or segment

May be acquired or congenital

Question 3

Acquired Bronchiectasis-Pulmonary Infection

Answer 3

Repeated and prolonged respiratory infection

Frequent bronchopneumonia in children ® Bronchiectasis as adults

Significant lung infection in childhood can cause anatomical alterations in the developing lungs which lead to more infections and ultimately bronchiectasis

Question 4

Acquired Bronchiectasis-Bronchial Obstruction

Answer 4

Caused by tumour, enlarged lymph node ® impaired mucociliary clearance ® bacterial infection ® bronchiectasis distal to obstruction

Question 5

Acquired Bronchiectasis-Pulmonary Tuberclosis

Answer 5

Inflammatory changes and bronchial wall destruction ® bronchiectasis as secondary complication

Question 6

Types of Acquired Bronchiectasis

Answer 6

Pulmonary infection

Bronchial obstruction

Pulmonary Tuberclosis

Question 7

Types of Congenital Bronchiectasis-Cystic Fibrosis

Answer 7

Abundance of thick, stagnant mucus

Impaired mucocillary clearance

Bronchial obstruction

Necrotizing inflammation and infection

All the above lead to secondary bronchiectasis

Question 8

Types of Congenital Bronchiectasis-Hypogammaglobulinemia

Answer 8

Inherited/acquired immune deficiency disorders

High risk for respiratory infections

Cystic fibrosis

Abundance of thick, stagnant mucus

Impaired mucocillary clearance

Bronchial obstruction

Necrotizing inflammation and infection

All the above lead to secondary bronchiectasis

Question 9

Types of Congenital Bronchiectasis-Kartageners Syndrome

Answer 9

Accounts for 20% of congenital bronchiectasis

Triad consisting of bronchiectasis, dextrocardia (hart on right side of the body) and paranasal sinusitis

Question 10

Types of Congenital Bronchiectasis

Answer 10

Kartageners Syndrome

Hypogammaglobulinemia

Cystic fibrosis

Question 11

Pathophysiology of Bronchiectasis

Answer 11

1. Bronchial Wall Destruction
2. Impaired Mucocillary Mechanism
3. Copious Amount of Foul Smelling Sputums
4. Distal Bronchioles Obstruction with Secretions
5. Hyperinflation of Distal Aveoli/Atelectasis Consolidation and Parachymal Fibrosis
6. V/Q Mismatch, Hypoxemia, Increased WOB, Cor Pulmonale

Question 12

Cylindrical Classification

Answer 12

Regular pattern with the airway wall of the bronchioles uniformly dilated in a cylinderical shape

Occurs for 6-10 generations and appears to end squarely on bronchogram due to mucus obstruction

Increased bronchial markings

Emphysema

Question 13

Varicose Classification

Answer 13

Irregular pattern with areas of constriction and dilation

End in a distorted bulbous shape

Question 14

Cystic/Saccular Classification

Answer 14

A progressive increase in diameter with distal enlargement of airways resulting in sac like structures in lung parenchyma

Causes most damage to tracheobronchial tree

Loss of cartilage, elastic tissue and smooth muscle with fibrous tissue forming bronchial walls

Fibrotic markings

Atelectasis

Emphysema

Question 15

Hgh Resolution CT Scan

Answer 15

Has known mostly replaced bronchoscopy for classifying bronchiectasis

Question 16

Severe bronchiectasis is associated with:

i. Vesicular breath sounds
ii. Cor pulmonale
iii. JVD
iv. Polycythemia

Answer 16

ii. Cor pulmonale
iii. JVD
iv. Polycythemia

Question 17

The clinical manifestations are a result from the pathophysiologic mechanisms caused (or activated) by

Answer 17

Atelectasis

Consolidation

Excessive Bronchial Secretions

Question 18

Clinical Manifestations

Answer 18

Cough, sputum production, and hemoptysis

A chronic cough will produce large quantities of foul smelling sputum which is a hallmark of bronchiectasis

Question 19

Sputum Examination

Answer 19

Streptococcus pneumonia

Haemophilus influenza

Pseudomonas aeruginosa

Anaerobic organisms

Question 20

General Treatment Includes

Answer 20

Controlling Pulmonary Infections

Controlling Airway Secretions

Preventing Complications

Question 21

Other Treatment Options Include

Answer 21

Bronchopulmonary Hygiene

Supplemental Oxygen Therapy

Mechanical Ventilation

Surgical Resection of Localized Area

Lung Transplant

Question 22

Respiratory Care Treatment Protocols

Answer 22

Oxygen therapy protocol

Bronchopulmonary hygiene therapy protocol

Hyperinflation therapy protocol

Aerosolized medication protocol

Mechanical ventilation protocol

Question 23

Medications

Answer 23

Antibiotics

Mucolytic agents

Bronchodilators/anticholinergics/ xanthines

Expectorants