1. Bronchiectasis

2. DEFINITION OF BRONCHIECTASIS It is a chronic and necrotizing condition of bronchi and bronchioles leading to their abnormal dilatations. OR Bronchiectasis is anatomically defined as abnormal, irreversible dilatation and distortion of bronchi caused by inflammatory destruction of the muscular and elastic components of bronchi.

3. PREVALANCE OF BRONCHIECTASIS 52 per 100,000

4. CAUSES OF BRONCHIECTASIS Bronchial obstruction Tumor Foreign body Impaction of copious mucus (Asthma, Ch. Bronchitis)

5. CAUSES OF BRONCHIECTASIS Chronic Respiratory Infection Tuberculosis Foreign body aspiration Chronic cystic malformation Immunodeficiency Undiagnosed mass

6. CLINICAL FEATURES OF BRONCHIECTASIS COUGH & SPUTUM: Cough and mucopurulent sputum Cough is invariably present and in many patients cough is the only symptom for initial few years. Sputum is Purulent, Tenacious and Foul smelling, more in morning. HEMOPTYSIS: Present in 40-70 % of patients and may vary from blood streaks to large clots or significant fresh bleed. DRY BRONCHIECTASIS: Cough with scanty sputum with or without hemoptysis.

7. CLINICAL FEATURES OF BRONCHIECTASIS Acute Exacerbation: Increasing cough Increased Dyspnea Increased volume of sputum production Fever Hemoptysis Chest pain

8. BRONCHIECTASIS–CLINICAL EXAMINATION Chest auscultation: Prolonged expiration Coarse crackles Diffuse Rhonchi Bronchial breathing in selected cases in pneumonias. Digital clubbing Hypertrophic pulmonary osteoarthropathy Cor pulmonale

10. DIAGNOSIS OF BRONCHIECTASIS History Physical examination X-ray Chest Sputum cultures for bacteria, fungi and mycobacteria.

11. BRONCHIECTASIS-CLINICAL FEATURES Cough Fever Copious amount of foul smelling sputum Dilatation is permanent Reversible dilatation occurs in viral and bacterial pneumonia.

12. BRONCHECTASIS-GROSS MORPHOLOGY Affect lower lobes more Often bilateral More in air passages which are vertical In tumor or foreign body impaction it is localized or segmental If more distal bronchi are involved more severe Airways are usually four times dilated than normal

13. BRONCHECTASIS-GROSS MORPHOLOGY Cylindrical- most common, tube like, increased in diameter Fusiform – spindle shaped dilatation Saccular -sac like dilatation, like grapes. Varicose- irregular bronchial dilatations and tortuosities of bronchial passages. Imagine varicose veins. Cut sections show Honey Comb appearance

21. TRACTION BRONCHIECTASIS It is distortion of the airways secondary to mechanical traction on the bronchi from fibrosis of the surrounding lung parenchyma. for example after toxic gas exposure like by chlorine gas and ammonia, leads to irreversible damage to airways.

22. BRONCHIECTASIS-CHEST XRAY FINDINGS Increased pulmonary markings Ring like structures Atelectasis Dilated and thickened airways (Tram lines) Mucus plugging (Finger in glove appearance)

31. BRONCHIECTASIS-TREATMENT Controlling infection Reducing inflammations Improving bronchial hygiene Surgical resection of affected segment in selected patients.

32. BRONCHIECTASIS-TREATMENT CONTROL OF INFECTION Antibiotics for acute exacerbations Prophylactic in few cases Oral Flouroquinolones are commonest. Mostly for 10-14 days.

33. BRONCHIECTASIS-TREATMENT BRONCHIAL HYGIENE Chest percussion Postural drainage Mechanical vibration by ultrasonic devices Positive expiratoty pressure Flutter valve technique

34. BRONCHIECTASIS -TREATMENT In case of lack of response to treatment culture and sensitivity tests for sputum are done for better selection of antibiotics. May need injectible treatments May need hospitalization

35. TREATMENT - BRONCHIECTASIS MUCUS CLEARANCE Mucus hypersecretion is a prominent feature of bronchiectasis. Maintenance of adequate hydration by oral or intravenous fluids is helpful to avoid tenacious inspissated sputum retention. Humidification of air or oxygen is used as an adjunct to chest physiotherapy. Nebulization of normal or hypertonic saline Use of acetyle cystine or other mucolytic agents

36. BRONCHIECTASIS –TREATMENT BRONCHODILATORS As there is airway obstruction and mucosal hyperreactivity so bronchodilators are often used.

37. BRONCHIECTASIS-TREATMENT ANTI-INFLAMMATORY AGENTS Persistent endobronchial inflammation is known to be play a significant role in pathophysiology of bronchiectasis so anti- inflammatory treatment may be beneficial.

38. BRONCHIECTASIS-TREATMENT SURGERY For Symptoms control Control of bleeding Reduction of tenacious sputum production Reduction of acute exacerbations Improved quality of life Surgery of selected segments is indicated in : Most severely affected segments Recurrent bleeding segments Segments harboring resistant tuberculosis or other micro-organisms

39. BRONCHIECTASIS-TREATMENT MISCELLANEOUS LUNG TRANSPLANT: A viable option in selected cases VACCINATIONS STOP SMOKING OXYGEN INHALATION

40. BRONCHIECTASIS-COMPLICATIONS General Hemoptysis Toxemia Amyloidosis Septicemia Septic shock Metastatic abscesses(Brain) Lung Lung abscess Pneumonia Pleuricy Empyema Cor pulmonale

41. CILIARY DYSKINESIA Immotile cilia syndrome Kartagener’s Syndrome

42. CLINICAL FEATURES OF CILIARY DYSKINESIA Repeated bouts of otitis and sinusitis Recurrent Chest Infection Situs invertus (50%) Males- infertility

43. KARTAGENER’S SYNDROME Bronchiectasis Sinusitis Situs invertus Male infertility