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

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

4. 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.

6. ETIOLOGY:
Bronchiectasis has both
congenital and acquired
causes.

7. THE YELLOWISH DISCOLORATION OF LUNG
PARENCHYMA REFLECTS OBSTRUCTIVE PNEUMONIA.

8. ACQUIRED CAUSES
 Tuberculosis,
 pneumonia,
 inhaled foreign bodies,
 allergic bronchopulmonary aspergillosis and
bronchiol tumours are the major acquired
causes of Bronchiectasis.

9. INFECTIVE CAUSES ASSOCIATED WITH
BRONCHIECTASIS INCLUDE
 infections caused by
the Staphylococcus,
Klebsiella, or
Bordetella pertussis,
the causative agent of
whooping cough.

10. 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

11.  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 the
lungs causes tissue damage.

12. 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,

13. MORPHOLOGICAL TYPES
 Cylindrical or tubular bronchiectasis
 Varicose
 saccular or cystic bronchiectasis

14. 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
PATTERNS OF BRONCHIECTASIS

15. CYLINDRICAL OR TUBULAR BRONCHIECTASIS

16. Varicose bronchiectasis
4. Diagnosis – Chest CT

17.  Saccular (cystic) bronchiectasis:
The bronchi have a ballooned appearance at the
periphery, ending in blind sacs without
recognizable bronchial structures distal to the
sacs

18. CYSTIC BRONCHIECTASIS

19. Cystis / saccular
bronchiectasis
4. Diagnosis – Chest CT

21. 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

22. PATHOPHYSIOLOGY
Dilation and distortion of the
bronchi
Damage of airway epithelium
Dilation and hyperplasia of
blood capillary

23. Bronchiectasis Pathophysiology
Airway Injury +
Secretion Stimuli
Secretion Stasis Infection
Airway Destruction +
Airway Dilation

26. 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

27. 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

28. 4. Recurrent pneumonia:
same segment
5. Systemic manifestations:
fever, weight loss

29. 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

30. 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).

31. Dilated bronchus
BRONCHIECTASIS

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

33. COMPLICATION
Local complication
 Recurrent pneumonia
 Lung abcess
 Empyema
 Hemoptysis
 Pulmonary hypertension

34. Systemic complication
 Hypoproteinemia &amyloidosis
 Generalized edema (100gm sputum/4_5 g
protein)protein loosing pneumopathy

35. 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.

36. 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

37. TREATMENT
 Medical management
1. Improving the drainage of airway
1) expectorant
2) bronchodilators
3) postural drainage

38. 2. Antibiotic
 The choice of antibiotics should be
accurately by the results of sputum
culture and drug sensitivity test.
 Empirical therapy ---
antipseudomonal antibiotics.

39. 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

40. BRONCHODILATER
 Bronchodilators to improve
obstruction and aid clearance
of secretions are useful in
patients with airway
hyperreactivity and reversible
airflow obstruction

41.  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

42. Surgical resection
Bronchial arterial embolization
Although resection may be successful if disease
is localized, embolization is preferable with
widespread disease

43. NURSING MANAGEMENT:
 History and physical examination
 Obtain history regarding amount
and characteristics of sputum
produced, including haemoptysis.
 Auscultate lungs for diffuse rhonchi
and crackles.

44. NURSING DIAGNOSIS
 Ineffective Airway Clearance related to
tenacious and copious secretions