bronchectasis

1. BRONCHIECTASIS
' An irreversible and abnormal dilation
of bronchial tree that produces chronic
respiratory symptoms'

2. BRONCHIECTASIS
LOCAL INFECTION OR INFLAMMATION
+
INADEQUATE CLEARANCE OF SECRETIONS
AIRWAY OBSTRUCTION IMPAIRED HOST DEFENSES

3. BRONCHIECTASIS
Clinical Features:-
- Chronic productive cough (months to
years) with copious mucopurulent
sputum
- Dyspnea
- Hemolysis
- Clubbing

4. BRONCHIECTASIS
Diagnosis:-
- Chest X Ray (Best Initial Test)
- High Resolution Computed
Tomography (HRCT) (Confirmatory
Test)
- Sputum Culture & Smear
(exacerbations)
- Spirometry (not for diagnosis but
monitoring disease progress)

5. BRONCHIECTASIS
Long Term Management:-
- Goal is to reduce exacerbation
frequency to _< 2 per year

6. BRONCHIECTASIS
General Measures:-
- Smoking Cessation
- Chest Physiotherapy
- Cupping, Clapping, postural drainage
- Vaccination
- Seasonal Influenza
- Pneumococcal vaccine

7. BRONCHIECTASIS
Bronchodilators:-
- SABA
- LABA (patients with serve dyspnea)
- Corticosteroids:-
- Not routinely recommended
- Use only if patient is already taking
for asthma

8. BRONCHIECTASIS
Pharmacotherapy:-
Mucoactive Agents:-
- Nebulized hypertonic Saline
- (3-7% NaCl)
- Oral Mucolytics:-
- N – Acetylcysteine

9. BRONCHIECTASIS
Long Term Antibiotic Therapy:-
- Consider of _> 3 exacerbation per year
- Take Sputum Cultures First
- Example :-
Absent – Oral Azithromycin 250 mg
Daily 3 times / week - QT Prolongation
- Pseudomonas
Present – Tobramycin 300 mg Neb e 12 hrs
Aztreonam 75 mg Neb e 8 hrs

10. BRONCHIECTASIS
To avoid bronchospasm
Bronchodilator
Mucoactive Agents
Chest Physiotherapy
Inhaled Antibiotics

11. BRONCHIECTASIS
Invasive Procedures:-
- Surgical Resection of Bronchiectasis Lung
- Lobectomy
- Lung Transplant

12. BRONCHIECTASIS
Follow Up:-
- Follow up every 6-12 months
- Yearly Spirometry
- Sputum Cultures (6-12 months)
- Perform:-
- ECG , Echo, CT Chest with Contrast

13. BRONCHIECTASIS EXACERABATION
MANAGEMENT

14. BRONCHIECTASIS
Exacerbation of Bronchiectasis:-
- O2
- Mucoactive Agents
- Obtain New Sputum Culture
- Start Empiric Antibiotic therapy based on most recent culture report
- Tailor Antibiotic Therapy
- Hemodynamically Stable Hemodynamically Unstable
Sent home 14 day antibiotic therapy Treat Inpatient IV Antibiotics