Bronchiectasis

Definition

Chronic suppurative lung disease characterized by permanent abnormal dilatation of bronchi manifested by sputum production ,progressive scaring and lung damage

Commonest site-Left lower lobe and lingula

Bronchiectasis sicca/dry bronchiectasis

It is a special type where there is dry cough associated with occasional hemoptysis

Etiology

1.Congenital-Cystic fibrosis ,ciliary dysfunction ,immotile cilia syndrome ,kartagener's syndrome(Sinusitis with transposition of viscera)

2.Acquired

For children-Pneumonia ,primary TB

Adult-Pulmonary TB pneumonia ,aspergillosis

Types-Cylindrical , cystic ,fusiform

Pathogenesis

Chronic inflammation and fibrotic change in lung tissue

Clinical features

Symptoms-Chronic daily persistent productive copious cough more marked in morning after waking up  ,purulent sputum ,hemoptysis and halitosis

Signs-

           Clubbing

           Features of consolidation-Percussion note dull ,breath sound bronchial

Causes of basal crepitation

Unilateral-Unilateral bronchiectasis ,lung abcess

Bilateral-LVF ,bilateral bronchiectasis ,ILD ,pul edema

Bilateral with clubbing-ILD ,fibrosing alveolitis

Differential diagnosis

           Intestitial lung disease(ILD)

          TB

Investigation

FBC with TC DC WBC(Neutrophilic leucocytosis) ,Hb and ESR

CXR ray

           Normal in early stage

           In advanced stage-Ring with clear centre/honeycomb/with or without fluid level ,linear streak/tram line ,thick bronchi

Lung function test-Obstructive type

Sputum culture(Pseudomonas ,aspergillosis ,TB)

HRCT scan(Definitive)[1-2 mm thick ,but in CT 10mm thick]

Ciliary dysfunction test-Time taken for a small pellet of saccharin placed in the anterior chamber of the nose to reach the pharynx, when the patient can taste it. This time should not exceed 20 minutes but is greatly prolonged in patients with ciliary dysfunction.(Davidson)

[Bronchiectasis with Nephrotic syndrome-Amyloidosis]

Treatment

1.Physiotherapy-Deep breathing followed by forced expiratory manoeuver via hand clapping at the back of the chest(Active cycle of breathing)

2.Postural drainage

3.Antibiotics-Macrolides ,ciprofloxacin

4.Surgery-Excision of bronchiectatic area

[Prognosis if bad if cystic fibrosis is present ,otherwise good if physiotherapy is given in non complicated case]

Complication

Pneumonia

Pleurisy

Lung abcess

Pleural effusion ,empyema

Amyloidosis

Prevention

Prophylaxis for measles ,whooping and TB