1. DR . ABDUL HAMEED AL QASEER
Bronchiectasis
DR . ABDUL HAMEED AL QASEER

2. BRONCHIECTASIS Definition: Abnormal and permanent dilation of bronchi.
Focal or diffuse distribution
Clinical consequences – chronic and recurrent infection and
Pooling of secretions in dilated airways.
Classification:
Cylindrical (fusiform)
Saccular
Varicose

3. The induction of bronchiectasis required :
The affected airways show a variety of changes including transmural inflammation ,mucosal edema ,& ulcerations .
The induction of bronchiectasis required :
1. an infectious insult airways obstruction .
3. reduced clearance , &/or a defect in host defense .

4. Aetiology: A. Infections-Micro-organisms
Measles and Pertussis
Adeno & Influenza virus
Bacterial infection with virulent organisms: S.aureus, Klebsiella Anaerobes
Atypical mycobacteria
Mycoplasma
HIV
Tuberculosis
Fungi

5. AETIOLOGY : IMPAIRED HOST DEFENCE
Local causes: Endobronchial obstruction
Generalised impairment:
1. Immunoglobulin deficiency
2. Primary ciliary disorders
3. Cystic fibrosis

6. AETIOLOGY : NON-INFECTIOUS
Toxins or toxic substances NH3; gastric contents
Immune responses, ABPA
Inflammatory diseases: ulcerative colitis, rheumatoid arthritis, Sjögren syndrome.
-1-Antitrypsin deficiency
Yellow nail syndrome

7. Causes of Bronchiectasis

9. CLINICAL MANIFESTATIONS
Persistent or recurrent cough with purulent sputum.
Haemoptysis
Initiating episode: Severe pneumonia, or insidious onset of symptoms or asymptomatic or non-productive cough – dry bronchiectasis in upper lobe,
Dyspnoea, wheezing – widespread bronchiectasis or underlying COPD.
Exacerbation of infection: Sputum volume increase, purulence or blood.

10. Symptoms of Bronchiectasis

11. PHYSICAL EXAMINATION Any combination of rhonchi, creps or wheezes.
Clubbing of digits.
Chronic hypoxaemia  cor pulmonale  R heart failure
Amiloidosis (rare)

12. DIAGNOSIS - 1 Clinical Radiology: Chest XR: May be non-specific
mild disease – normal XRC
advanced disease – cysts + fluid levels
peribronchial thickening, “tram tracks”, “ring shadows”
CT Scan: Peribronchial thickening, dilated bronchioles.
Sputum culture: Pseudomonas aeuruginosa, H.influenzae.

14. DIAGNOSIS - 2 Lung function: Airflow obstruction – FEV1 decreased.
Air trapping - RV increased
Sweat test – increased sodium and chloride in cystic fibrosis
Bronchoscopy: Obstruction – foreign body, tumor.
Immunoglobulin
Cilia function and structure – Kartagener syndrome.

18. TREATMENT - 1 4 Goals: 1. Eliminate cause 2. Improve tracheo bronchial
clearance
3. Control infection
4. Reverse airflow obstruction

19. TREATMENT - 2 2. Antituberculous drugs 3. Corticosteroids (ABPA)
1. Immunoglobulin
2. Antituberculous drugs
3. Corticosteroids (ABPA)
4. Remove aspirated material
Chest physical therapy
Mucolytics
Bronchodilators

20. TREATMENT - 3
Antibiotics – short course, prolonged course, intermittent regular courses, inhalation.
Initial empiric Rx: Ampi, Amox, Cefaclor, Septran
Ps.aeruginosa – Quinolone, aminoglycoside, 3rd generation cephalosporin, pipracillin.
Surgery:
Oxygen and diuretics
Lung transplant

21. Antibiotic therapy
For most patients with bronchiectasis , the appropriate antibiotic are the same as those used in COPD ; however , in general , larger doses & longer courses are required .
If the patients not improved antibiotic therapy should be guided by the microbiological sensitivity for example , Pseudomonas species , oral ciprofloxacine ( mg / 12h) or ceftazidime I.V. (1-2g /8h ) .

22. Complications

23. Surgical treatment
Surgical excision in bronchiectasis is indicated in few cases .
Young patients with unilateral disease & confined to a single lobe or segment who not controlled by medical therapy may get benefit from surgery .
Unfortunately ,many patients in whom medical treatment unsu – ccessful are also unsuitable for surgery because of either extensive disease or coexisting chronic lung disease .

24. Cystic Fibrosis
CF is an autosomal recessive disease as a result of mutation affecting a gen on the long arm of chromosome 7 , which codes for a chloride known as cystic fibrosis transmembrane cond - uctance regulator CFTR.
CF is a monogenic disorder that presented as a multisystemic .
The first signs & symptoms occur in childhood , but ~ 5% of patients in US diagnosed in adulthood . Because of improvement in therapy ~ 46% now > 18 years & > 16% are > 30 years old .

27. Clinical manifestation
The upper & lower respiratory tract are commonly affected in CF

28. Other complications

29. Diagnosis of CF
The diagnosis of CF rests on the combination of clinical features & abnormal CFTR function.
Sweat test :
Elevated sweat chloride are nearly pathognomonic in CF ( >
70 meq /l in adult)
2. Nasal transepithelial electric PD
3. CFTR mutation analysis .

30. Management of CF
The management of CF is that of severe bronchiectasis .
Regular nebulised antibiotics therapy ( colomycin or tobramycin ) is used to suppress chronic Pseudomonas infection ..
Aspergillus & atypical mycobacterium are also frequently found .
Some patients with CF have coexistent asthma .
There is a clear link between good nutrition& prognosis in CF .
Malabsorption is treated with oral pancreatic enzymes & vitamins
Diabetes eventually appears in 25% .
Osteoporosis secondary to malabsorption should be treated .
Somatic gene therapy may the near future therapy .

31. Treatment that reduced exacerbations &/or improved lung function in CF

33. THANK YOU