Module 5 Bronchiectasis Flashcards
Define Bronchiectasis
A long-term condition where the airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection.
Pathology:
Dilated w/recurrent resp. infections cause mucus
Airways become ultra floppy (distortion of bronchi) - caused by bronchial wall destruction-resulting in bronchial secretions
Where does Bronchiectasis usually occur?
- characterization of disease?
Edit
Bronchiectasis can occur in any part of the lung, but it typically affects the lower lobes
In the context of chronic airway infection causing inflammation.
- characterized by mild to mod airflow obstruction (worsening over time)
What elements are crucial to keep lungs free of infection?
mucous clearance and local defence mechs. against microorganisms
Implications of repeated infections when bronchi are impaired?
Repeated infections can cause damage to the bronchi wall; further impeding the clearance of mucous
What causes Bronchiectasis?
Extensive inflammation and destruction of bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscle components
What does bronchial wall destruction lead to?
muscular clearance defiances (lots of bronchial secretions and blood leading to static sputum)
How would early tests reflect Bronchiectasis.
- which diagnostic tests would be performed for advance progression?
- Early stage: CT and Spirometry =
normal - Advanced stage can be seen on PFT = it’d show obstruction
What would lead to secondary bronchial smooth muscle constriction and fibrosis?
Multiple infections and constant irritation.
Bronchiectasis leads to which anatomic alterations?
Hyperinflation or Atelectasis
What symptoms and complications do patients w/bronchiectasis typically get?
chronic airway infection,
- punctuated by acute exacerbations
- accompanied by progressive airflow obstruction
Bronchiectasis sees a increase in what aspects?
Compliance and Airway Resistance
3 main congenital conditions where you see Bronchiectasis
- Kartageners syndrome
- Hypogammaglobulinemia
- cystic fibrosis
Can distribution of bronchiectasis be characterized as diffused or generalized?
Both Diffuse or generalized; affecting many areas of the lungs
More commonly
Focal or localized: appearing in only 1 or 2 lung areas
Diffuse Bronchiectasis develops in pts w/what?
Genetic, immunologic, or anatomic defects that affect airways that lead to airway obstruction and/or chronic infection + extensive inflammation.
- pneumonia
- TB
- RSV
- cystic fibrosis (Mucocillary disorders)
- Foregin body aspiration/COPD/Congenital (less common)
What happens when diffuse bronchiectasis progresses
Inflammation would spread beyond the airways to the lung parenchyma, causing fibrosis
What is Diffuse Bronchiectasis
Chronic IRREVERSIBLE dilation and distortion of bronchi
- Leads to mucosaciliary clearance deficiencies (Bad bronchial hygiene)
Extra Info:
when a case disorder triggers inflammation of small and medium sized airways, releasing inflammatory mediators from intraluminal neutrophils Resulting in irreversible bronchodilation
Inflamed medium and small airways, macrophages and lymphocyte form infiltrates that thicken mucosal walls.What does thickening of mucosal walls implicate?
Thickening will cause airway obstruction
What are 3 types of Bronchiectasis?
- Diffuse
- Focal
- Congenital
When does Focal Bronchiectasis occur?
A large airway becomes obstructed
Describe focal bronchiectasis
The inability to clear secretions leads to the “vicious cycle hypothesis” which describes a cycle of infection:
- first inflammation and bronchial wall damage occur
- followed by mucocillary clearance impairment
- followed by fibrotic tissue development
- last line of development would be atelectasis
What section of the respiratory system is most affect by focal bronchiectasis?
The right middle lobe, because its bronchus is small and angulated, and has lymph nodes in close proximity (sites of high infection)
What can cause bronchial obstruction and focal bronchiectasis?
Lymphadenopathy due to myocardial infection
(Lymphadenopathy = enlargement of lymph nodes” = immune/inflammation response)
Is Bronchiectasis a obstructive or restrictive disease?
Obstructive
Gold diagnosis of bronchiectasis
CT scan
Anatomic alterations caused by Bronchiectasis?
Either:
(1) Hyperinflation of the distal alveoli as a result of expiratory check-valve obstruction
(2) Atelectasis, Consolidation, and fibrosis resulting from complete obstruction of the bronchi
why does diffuse bronchiectasis result in irreversible bronchodilation?
Destroys elastin, cartilage, and muscle in large airways = irreverisable bronchodilation.
Macrophages and lymphocytes thicken the mucosal wall and cause airway obstruction
What can diffuse bronchodilation lead to?
as it progresses, inflammation will lead to fibrosis in the lungs
Where does Focal bronchiectasis occur?
RML, occurs when a large airway becomes obstructed
Why does Focal bronchiectasis frequently affect the RML?
The RML is affected bc the bronchus is small and angulated w/lymph nodes nearby.
- Poor drainge and mucus clearance in respect to other lobes (letting it accumulate)
- RML also has limited collateral circulation
- Prone to recurrent or chronic infections
Describe bronchiectasis acquired by pulmonary infection
Recurrent and prolonged pulmonary infections leading to permanent dilation/disortion of bronchial walls
- Inflammation and wall damage reduces cillary function and elastic smooth muscle strength
- Stagnant mucus is a breeding ground for bacteria/colonizatino of recurrent infections
- Frequent bronchopneumonia in children and developing bronchiectasis in adulthood
Etiology of bronchiectasis acquired as a result of bronchial obstruction
- An obstruction or foregin body (i.e tumour or enlarged lymph node) impairs ciliary clearance by blocking the bronchus allowing bacteria to colonize and cause infection.
- Bronchiectasis development occurs when inflammation/elastic tissue gets destroyed by inflammatory mediators leading to permenant dilation.
- The cycle is reoccurent (chronic) if inflammation/infection is not addressed
How would tuberculosis lead to bronchiectasis
Inflammatory changes and bronchial wall obstruction with bronchiectasis being secondary to intial infection.
- Same presention as Pneumonia
- Severe inflammation + mucous production = destruction of elatsic tissue.
Kartageners syndrome
accounts for 20% of congenital bronchiectasis
Triad including: bronchiectasis, dextrocardia and paranasal sinusitis
Hypogammaglobulinemia
Inherited acquired immune deficiency disorders.
Results in a low antibody count, causes high risk of respiratory infections.
Cystic fibrosis
autosomal recessive disorder
-abundance of thick stagnant mucus
-Impaired mucociliary clearance
-Bronchial obstruction
-can lead to secondary bronchiectasis
Cyndrical bronchiectasis
regular pattern in the airway wall that is dilated and RIGID.
Occurs for 6-10 generations and ends abruptly due to obstruction.
Varicose bronchiectasis
Irregular pattern with areas of constriction and dilation
Distorted bulbous shape.
What is the difference between bronchiectasis and asthma?
-Bronchiectasis is caused by damage and widening of the bronchial tubes, leading to recurrent infections.
-Asthma is caused by chronic inflammation of the airways, leading to episodes of breathing difficulty and wheezing.
What are examples of conditions/disorders than can lead to Bronchiectasis?
Cystic fibrosis, immune system disorders, or recurrent lung infections.
Recall;
Bronchiectasis is a chronic lung condition in which the bronchial tubes, which are the airways that lead to the lungs, become abnormally widened and damaged. This can lead to a build-up of mucus and bacteria in the airways, which can cause recurrent lung infections, chronic coughing, and difficulty breathing.
What are some differences between Diffuse and Focal Bronchiectasis?
Diffuse = multiple bronchi throughout long are affected; associated w/underlying conditions generalized systemic diseases
focal = **pattern w/only one bronchi affected leading to localized areas of Broncho dilation; often associated w/prior lung infections like pneumonia or inflammation
What do both diffuse and focal bronchodilation have in common?
Coughing, difficulty breathing, and recurrent lung infections.
What is mechanical insufflation/exsufflation therapy [MI-E]?
(MI-E) therapy is a technique used to help clear mucus from the airways of patients w/conditions such as neuromuscular diseases, spinal cord injuries, or other conditions that impair cough function.
Method:
A device that delivers a series of rapid inflations and exhalations to the lungs, which helps to loosen and move mucus out of the airways.
When would mechanical insufflation/exsufflation therapy [MI-E] be used?
1.Neuromuscular diseases, such as muscular dystrophy or spinal muscular atrophy, which can impair cough function and lead to difficulty clearing mucus from the airways.
- Spinal cord injuries or other conditions that affect the muscles involved in breathing and coughing.
- COPD, cystic fibrosis, or other respiratory conditions that lead to excessive mucus production and difficulty clearing the airways.
- Patients who have undergone lung transplant surgery, as MI-E therapy can help prevent the accumulation of mucus in the airways and reduce the risk of infection.
