Module 5 Bronchiectasis

Question 1

Define Bronchiectasis

Answer 1

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

Question 2

Where does Bronchiectasis usually occur?

• characterization of disease?

Edit

Answer 2

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)

Question 3

What elements are crucial to keep lungs free of infection?

Answer 3

mucous clearance and local defence mechs. against microorganisms

Question 4

Implications of repeated infections when bronchi are impaired?

Answer 4

Repeated infections can cause damage to the bronchi wall; further impeding the clearance of mucous

Question 5

What causes Bronchiectasis?

Answer 5

Extensive inflammation and destruction of bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscle components

Question 6

What does bronchial wall destruction lead to?

Answer 6

muscular clearance defiances (lots of bronchial secretions and blood leading to static sputum)

Question 7

How would early tests reflect Bronchiectasis.

• which diagnostic tests would be performed for advance progression?

Answer 7

• Early stage: CT and Spirometry =
  normal
• Advanced stage can be seen on PFT = it’d show obstruction

Question 8

What would lead to secondary bronchial smooth muscle constriction and fibrosis?

Answer 8

Multiple infections and constant irritation.

Question 9

Bronchiectasis leads to which anatomic alterations?

Answer 9

Hyperinflation or Atelectasis

Question 10

What symptoms and complications do patients w/bronchiectasis typically get?

Answer 10

chronic airway infection,
- punctuated by acute exacerbations
- accompanied by progressive airflow obstruction

Question 11

Bronchiectasis sees a increase in what aspects?

Answer 11

Compliance and Airway Resistance

Question 12

3 main congenital conditions where you see Bronchiectasis

Answer 12

• Kartageners syndrome
• Hypogammaglobulinemia
• cystic fibrosis

Question 13

Can distribution of bronchiectasis be characterized as diffused or generalized?

Answer 13

Both Diffuse or generalized; affecting many areas of the lungs

More commonly
Focal or localized: appearing in only 1 or 2 lung areas

Question 14

Diffuse Bronchiectasis develops in pts w/what?

Answer 14

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)

Question 15

What happens when diffuse bronchiectasis progresses

Answer 15

Inflammation would spread beyond the airways to the lung parenchyma, causing fibrosis

Question 16

What is Diffuse Bronchiectasis

Answer 16

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

Question 17

Inflamed medium and small airways, macrophages and lymphocyte form infiltrates that thicken mucosal walls.What does thickening of mucosal walls implicate?

Answer 17

Thickening will cause airway obstruction

Question 18

What are 3 types of Bronchiectasis?

Answer 18

1. Diffuse
2. Focal
3. Congenital

Question 19

When does Focal Bronchiectasis occur?

Answer 19

A large airway becomes obstructed

Question 20

Describe focal bronchiectasis

Answer 20

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

Question 21

What section of the respiratory system is most affect by focal bronchiectasis?

Answer 21

The right middle lobe, because its bronchus is small and angulated, and has lymph nodes in close proximity (sites of high infection)

Question 22

What can cause bronchial obstruction and focal bronchiectasis?

Answer 22

Lymphadenopathy due to myocardial infection

(Lymphadenopathy = enlargement of lymph nodes” = immune/inflammation response)

Question 23

Is Bronchiectasis a obstructive or restrictive disease?

Answer 23

Obstructive

Question 24

Gold diagnosis of bronchiectasis

Answer 24

CT scan

Question 25

Anatomic alterations caused by Bronchiectasis?

Answer 25

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

Question 26

why does diffuse bronchiectasis result in irreversible bronchodilation?

Answer 26

Destroys elastin, cartilage, and muscle in large airways = irreverisable bronchodilation.

Macrophages and lymphocytes thicken the mucosal wall and cause airway obstruction

Question 27

What can diffuse bronchodilation lead to?

Answer 27

as it progresses, inflammation will lead to fibrosis in the lungs

Question 28

Where does Focal bronchiectasis occur?

Answer 28

RML, occurs when a large airway becomes obstructed

Question 29

Why does Focal bronchiectasis frequently affect the RML?

Answer 29

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

Question 30

Describe bronchiectasis acquired by pulmonary infection

Answer 30

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

Question 31

Etiology of bronchiectasis acquired as a result of bronchial obstruction

Answer 31

1. 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.
2. Bronchiectasis development occurs when inflammation/elastic tissue gets destroyed by inflammatory mediators leading to permenant dilation.
3. The cycle is reoccurent (chronic) if inflammation/infection is not addressed

Question 32

How would tuberculosis lead to bronchiectasis

Answer 32

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.

Question 33

Kartageners syndrome

Answer 33

accounts for 20% of congenital bronchiectasis

Triad including: bronchiectasis, dextrocardia and paranasal sinusitis

Question 34

Hypogammaglobulinemia

Answer 34

Inherited acquired immune deficiency disorders.

Results in a low antibody count, causes high risk of respiratory infections.

Question 35

Cystic fibrosis

Answer 35

autosomal recessive disorder
-abundance of thick stagnant mucus
-Impaired mucociliary clearance
-Bronchial obstruction
-can lead to secondary bronchiectasis

Question 36

Cyndrical bronchiectasis

Answer 36

regular pattern in the airway wall that is dilated and RIGID.

Occurs for 6-10 generations and ends abruptly due to obstruction.

Question 37

Varicose bronchiectasis

Answer 37

Irregular pattern with areas of constriction and dilation
Distorted bulbous shape.

Question 38

What is the difference between bronchiectasis and asthma?

Answer 38

-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.

Question 39

What are examples of conditions/disorders than can lead to Bronchiectasis?

Answer 39

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.

Question 40

What are some differences between Diffuse and Focal Bronchiectasis?

Answer 40

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

Question 41

What do both diffuse and focal bronchodilation have in common?

Answer 41

Coughing, difficulty breathing, and recurrent lung infections.

Question 42

What is mechanical insufflation/exsufflation therapy [MI-E]?

Answer 42

(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.

Question 43

When would mechanical insufflation/exsufflation therapy [MI-E] be used?

Answer 43

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.

2. Spinal cord injuries or other conditions that affect the muscles involved in breathing and coughing.
3. COPD, cystic fibrosis, or other respiratory conditions that lead to excessive mucus production and difficulty clearing the airways.
4. 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.