bronchiectasis for B.Sc nursing, post basic B.Sc nursing students

1. Bronchiectasis
Bronchiectasis describes the irreversible and abnormal dilatation of
the airways.
It is a chronic lung condition, defined as the abnormal, irreversible
dilatation of the bronchi, where the elastic and muscular tissue is
destroyed by acute or chronic inflammation and infection. This
damage impairs the natural drainage of bronchial secretions which
can become chronically infected resulting airway obstruction.

2. Causes
Immune deficiency disorder that impared immune system such as
hivaids.
Mechanical obstruction due to any Foreign bodies, mucus plugging
etc Airway obstruction can lead to bronchiectasis.
Mucociliary clearance dysfunction: Ciliated epithelial cells are
essential to the normal function of the airways, progressively
clearing them of sputum. Dysfunction leads to mucus accumulation
and predisposes to recurrent infection. Causes include:
Congenital airway defects: Williams–Campbell syndrome: is a rare
disease characterized by defective cartilage in the airways resulting
in bronchiectasis.
Mounier-Kuhn syndrome: also termed tracheobronchomegaly, it is a
rare disease characterized by dilatation of the trachea itself as well
as the bronchi.

3. Rheumatic diseases: both rheumatic arthritis and Sjogren’s syndrome
have been associated with the development of bronchiectasis.
Allergic bronchopulmonary aspergillosis: ABPA, thought to be caused
by an exaggerated immune response to Aspergillus, tends to occur in
asthmatics and can lead to bronchiectasis.
COPD: patients with COPD who smoke are at increased risk of
repeated infection and this may lead to bronchiectasis.
Inflammatory bowel disease
Inhalation of toxic substance
Excessive alcohol substance and drug abuse.
Active and passive smoking.

4. types
Cystic Fibrosis Bronchiectasis (CFB) or Saccular bronchiectasis: Cystic
or saccular bronchiectasis is a genetic condition that causes thick, sticky
mucus to build up in the patient’s lungs, resulting in repeated pulmonary
infections. Like bronchiectasis, each cycle of inflammation and infection
further damages the bronchi, causing patients to exhibit signs of
bronchiectasis.

5. Non-Cystic Fibrosis Bronchiectasis (NCFB):Patients can also
develop bronchiectasis outside of CF. For instance, if a patient is living
with COPD has damaged cilia experiences asthma; or has impaired
muscular and nervous system functions that prevent them from
clearing mucus naturally, they may develop bronchiectasis-related
symptoms.
Cylindrical bronchiectasis, also known as tubular bronchiectasis, is
the most commonly identified morphologic type
of bronchiectasis where there is smooth uniform enlargement of
bronchi with loss of the normal distal tapering of the airways but
without focal outpouchings or tortuosity.

6. Pathophysiology
Due to any etiological factor
Ineffective pulmonary defense mechanism
Start inflammatory process and release inflammatory mediators
Impaired airway clearance
Sputum hypersecretions
Impaired mucociliary clearance
Damage or weak bronchial walls
Start lungs tissues necrosis and damage (It results from the
inflammatory destruction of the elastic and muscular components
of the airways.)
This leads to abnormally dilated airways, persistent sputum
production with ineffectual clearance and recurrent chest
infections.

7. Sign and Symptoms
Persistent sputum production
Persistent cough
Dyspnea
Hemoptysis
Weight loss
Crackles sound
High pitched inspiratory
Wheeze sound
Clubbing (rare)
Fatigue
Reoccurring chest pain
Tightness in chest
Foul smelling sputum production
Recount respiratory infection.

8. Diagnosis
History collection and physical examination.
Sputum shows the presence of hemoptysis (blood streaked)
Chest X-Ray shows consolidation (patches) of the lungs due to
mucus collection
High resonance computed tomography is done to confirm the
presence of dilated bronchus.
Sputum culture & sensitivity to identify the presence of bacteria
or virus.
Pulmonary function test shows decrease in forced expiratory
volume and functional vital capacity of the lungs.
Bronchoscopy
PFT

9. Management
Antibiotic therapy to treat infection specific to sputum
culture.
β2 agonists like albuterol, turbuteline to reduce
exacerbations of dyspnea.
Bronchodilator therapy with deriphylline, aminophylline
to increase airway compliance.
Mucolytic agents like benadryl and expecorants to
remove mucus secretions.
Chest physiotherapy to improve airway clearance.
O2 therapy
ventilator support if reacquired.
Advice for deep breathing exercise
Avoid air pollutants like cigarette smoking and irritants
like dusts, etc.

10. Surgical management:
Lobectomy: Surgical resection of the affected lobe to
prevent airway complications.
Segmental resection: A wedge portion of the affected
lung is resected.