BRONCHIECTASIS

Presented by ,
Mr. Maheboob
1st year M.sc Nursing
Govt college of nursing
Holenarsipur
 DEFINITION:

 Bronchiectasis is
defined as
permanent,
abnormal
dilatation of one
or more large
bronchi.
DEFINITION:

Bronchiectasis is defined as
abnormal and irreversible dilatation of
the bronchi and bronchioles (greater
than 2mm in diameter) developing
secondary to inflammatory weakening
of bronchial walls.
ETIOLOGY:

 Bronchiectasis has both

congenital and acquired

causes.
THE YELLOWISH DISCOLORATION OF LUNG PARENCHYMA REFLECTS OBSTRUCTIVE PNEUMONIA.
 
ACQUIRED CAUSES

 Tuberculosis,
 pneumonia,
 inhaled foreign bodies,
 allergic bronchopulmonary aspergillosis

and bronchiol tumours are the major

acquired causes of Bronchiectasis.

INFECTIVE CAUSES ASSOCIATED WITH
BRONCHIECTASIS INCLUDE

 infections caused by

the Staphylococcus,

Klebsiella, or

Bordetella pertussis,

the causative agent of

whooping cough.
ASPIRATION OF AMMONIA AND OTHER TOXIC GASES,

 pulmonary aspiration,
 alcoholism, heroin (drug use),
 various allergies all appear to be
linked to the development of
Bronchiectasis
 Childhood
Acquired Immune Deficiency Syndrome (AIDS
)
, which predisposes patients to a variety of
pulmonary ailments, such as pneumonia and
other opportunistic infections.
 Inflammatory bowel disease, especially
ulcerative colitis.
 A Hiatal hernia can cause Bronchiectasis
when the stomach acid that is aspirated into
CONGENITAL CAUSES

 Kartagener syndrome
 primary immunodeficiencies
 Williams-Campbell syndrome and
Marfan’s syndrome.
 Patients with alpha 1-antitrypsin
deficiency have been found to be
particularly susceptible to bronchiectasis,
 MORPHOLOGICAL TYPES

 Cylindrical or tubular
bronchiectasis

 Varicose

 saccular or cystic bronchiectasis

 PATTERNS OF BRONCHIECTASIS
Three different patterns of bronchiectasis have been
described
cylindrical bronchiectasis: the involved bronchi
appear uniformly dilated
varicose bronchiectasis: the affected bronchi have an
irregular or beaded pattern of dilatation resembling
varicose veins
CYLINDRICAL OR TUBULAR BRONCHIECTASIS
4. Diagnosis – Chest
CT

Varicose bronchiectasis
 Saccular (cystic) bronchiectasis:
The bronchi have a ballooned appearance at the
periphery, ending in blind sacs without
recognizable bronchial structures distal to the
sacs
CYSTIC BRONCHIECTASIS
4. Diagnosis – Chest
CT

Cystis / saccular
bronchiectasis
 Due to etiological factor

Inflammation of bronchial wall

causing
Loss of supporting structure
Result in
Thick sputum that obstruct the bronchi

The bronchial wall become

permanently dialated and distorted
 PATHOPHYSIOLOGY

 Dilation and distortion of

the bronchi
 Damage of airway
epithelium
 Dilation and hyperplasia
of blood capillary
Bronchiectasis Pathophysiology

Airway Injury +
Secretion Stimuli

Secretion Stasis Infection

Airway Destruction +
Airway Dilation
CLINICAL MANIFESTATION

1. The production of large quantities of purulent and

often foul-smelling sputum.
The volume of sputum can be used for
estimating the severity of the disease
 Mild < 10 mL
 Moderate 10~150 mL
 Severe >150 mL
2. Chronic cough
3. Hemoptysis:
 Frequent
 More commonly in dry variety
 Usually mild (blood streaking of purulent
sputum)
 Massive hemoptysis is usually from
dilated bronchial arteries or bronchial-
pulmonary anastomoses under systemic
pressure
4. Recurrent pneumonia:
same segment
5. Systemic manifestations:
fever, weight loss
SIGNS AND SYMPTOMS

 Chronic cough with foul smelling sputum

production,
 Some people with bronchiectasis may
produce frequent green/yellow sputum (up
to 240ml (8 oz) daily).
 Bronchiectasis may also present with
hemoptysis
 Pneumonia
 Bad breath indicative of active infection.
 Frequent bronchial infections and
breathlessness are two possible indicators
of bronchiectasis.
DIAGNOSTIC EVALUATION:

 History and physical examination

 Chest x-ray
 CT (computerised tomography) scan
 Blood tests
 Testing of the mucus to identify any
bacteria present
 Checking oxygen levels in the blood
 Lung function tests (spirometry).
 Dilated bronchus

BRONCHIECTASIS
COMPLICATIONS

 Progressive suppuration.
 Haemoptysis, major pulmonary
haemorrhage.
 COPD,
 emphysema,
 chronic respiratory insufficiency
 
COMPLICATION

Local complication
 Recurrent pneumonia
 Lung abcess
 Empyema
 Hemoptysis
 Pulmonary hypertension
Systemic complication
 Hypoproteinemia &amyloidosis
 Generalized edema (100gm
sputum/4_5 g protein)protein loosing
pneumopathy
TREATMENT

 Treatment of bronchiectasis includes

 controlling infections and bronchial secretions,
 relieving airway obstructions,
 removal of affected portions of lung by surgical
removal or artery embolization
 preventing complications.
TREATMENT

Therapy has several major goals:

(1)Treatment of infection, particularly during acute

exacerbations
(2) Improved clearance of tracheobronchial secretions

(3) Reduction of inflammation

(4) Treatment of an identifiable underlying problem

TREATMENT
 Medical management
1. Improving the drainage of airway

1) expectorant

2) bronchodilators
3) postural drainage
2. Antibiotic
 The choice of antibiotics should be
accurately by the results of sputum
culture and drug sensitivity test.
 Empirical therapy
---antipseudomonal antibiotics.
ANTIBIOTICS ARE THE CORNERSTONE OF BRONCHIECTASIS MANAGEMENT

 Antibiotics are used only during acute

episodes
 Choice of an antibiotic should be guided by
gram's stain and culture of sputum
 Empiric coverage (amoxicillin, co-
trimoxazole,levofloxacin) is often given
initially
BRONCHODILATER

 Bronchodilators to improve
obstruction and aid clearance of
secretions are useful in patients
with airway hyperreactivity and
reversible airflow obstruction
 Surgical management is indicated

1. Recurrent and refractory clinical

symptoms are due to a focal area
of disease involvement.

2. Massive hemoptysis
 Management of hemoptysis
 Surgical resection
 Bronchial arterial embolization
 Although resection may be successful if disease
is localized, embolization is preferable with
widespread disease
NURSING MANAGEMENT:

 History and physical examination

 Obtain history regarding amount and
characteristics of sputum produced,
including haemoptysis.
 Auscultate lungs for diffuse rhonchi
and crackles.
 NURSING DIAGNOSIS

 Ineffective Airway Clearance related

to tenacious and copious secretions