BRONCHIECTASIS

contents
Introduction
1 Definition
2 Aetiology and Pathogenesis
3 Pathology
4 Clinical features
5 Diagnosis
6 Complication
7 Treatment
 Introduction

 The word is from the Greek words:

bronchion and ektasis .

 It was first described in 1819 in an

infant who died following
whooping cough.
 By 1891 it was recognized that
bronchiectasis was 'not a separate
disease' but 'a result of various
affectations of the bronchi'.

 There is a general impression that

bronchiectasis is now less frequent
or at least less severe than
previously.
 This may reflect changes in:

–socio-economic conditions.
–the introduction of antibiotic
therapy for pulmonary infection,
–the control of tuberculosis,
–and effective vaccination for
whooping cough and measles.
1 DEFINITION

 Bronchiectasis is an chronic
abnormal and permanent
dilatation of bronchi.
 The diameter of those
airways are almost >2 mm.
2 ETIOLOGY AND
PATHOGENESIS
 Factors:
 Infections :
– Infections of bronchi and pulmonary
parenchyma
– Obstructive of bronchi
 Defect in host defense
mechanisms
 The other inflammatory diseases
 Etiological Factors of Bronchiectasis
Infectious Tuberculosis
Causes Whooping cough (pertussis )
Measles pneumonia
Adenovirus infections
Mycoplasma infections
Bacterial pneumonia
Human Immunodeficiency Viral Infection（HIV）
Bronchopulmonary Aspergillosis
Defect in Immunoglobulin Deficiency
host defense Mucociliary Dysfunction
mechanisms Primary Ciliary Dyskinesia
The other Rheumatoid Disease
inflammatory aspiration of acidic gastric contents
diseases inhalation of toxic chemicals such as ammonia
3 PATHOLOGY
inflamed,
tortuous,
collapsible,
ulceration,
microabscesses
saccular (cystic) bronchiectasis
 characteristic :
 permanent abnormal dilation
 destruction of bronchial walls

predilection site:
--left lung and in the lower lobes
--posterior segments of the upper lobes.
--middle lobe of right lung is the
predilection site of obstruction and
infection --- middle lobe syndrome.
Bronchial wall are inflamed, tortuous,
collapsible, ulceration,
microabscesses

Endobronchial contain secretions (partially or

totally),
obstructed,
Bronchial the columnar ciliated epithelium
is replaced by squamous
epithelium epithelium,
goblet cell and mucus land
hyperplasia
Peribronchial damaged or lost (leading to
dilated but collapsible airways)
connective tissue

Pulmonary dilatation, occlusion,

or hypertension ,
vascular
three major pathological types

 cylindrical bronchiectasis:
where there is uniform dilatation
 saccular bronchiectasis: where
there may be gross terminal dilatation
of the bronchi (saccules or cyst).
 varicose bronchiectasis: an
intermediate form
4 CLINICAL FEATURES

 ①symptom:
–persistent or recurrent
cough
–purulent sputum production
–intermittent hemoptysis
–pleurisy
–shortness of breath
–Febrile
 cough productive of large
quantities of mucopurulent
sputum -- classic symptom

–sputum production becomes

continuous and varies from
mucoid to purulent (occasionally
200 mL in 24 hrs),
 intermittent hemoptysis

 occurs in 50 to 70% of cases

 can be due to bleeding from
friable, inflamed airway
mucosa
 even massive bleeding:
because of hypertrophied
bronchial arteries
 "dry" bronchiectasis
 ②Physical examination

– milder cases may have no

physical findings.
– with severe, diffuse disease :
 crackles, rhonchi (diffuse)
and wheezes can be heared.
 chronic hypoxemia , cyanosis
 cor pulmonale
 right ventricular failure.
 cachexia,
 digital clubbing: rare
 ③chest radiography

– plate-like atelectasis,
– dilated and thickened airways
 tram or parallel lines;

 ring shadows on cross-

section
–irregular peripheral
opacities(represent
mucopurulent plugs )
 HRCT (High-resolution
computed tomography )

The thin section HRCT of the

chest is the gold standard
for the diagnosis of
bronchiectasis.
and has replaced the more
invasive investigation of
bronchography
diagnostic criteria of HRCT:

 both dilatation and thickening

– 'signet ring' sign (classic
appearance of a cross-section ) :
the internal diameter of the
bronchus is greater than the diameter
of its accompanying pulmonary artery
–tram or parallel lines
(in longitudinal section on CT ):
there is a failure of tapering as
the bronchus courses towards the
periphery
tram or parallel lines
 tram or parallel lines

CT（1mm 层厚）：两肺上叶支气管扩张呈“双轨状”“串珠状”左下叶背段与扫描层面 垂直的支气管扩张呈环形（“印戒征”）

mucopurulent plugs
bronchography
④ Examination of sputum :
–staining and culturing of
sputum to provide a guide
to antibiotic therapy.
5 DIAGNOSIS
 ①symptom and sign:
– chronic cough, large amount of sputum
production, and (or) recurrent intermittent
hemoptysis.
– diffuse rales and wheezes on chest
examination.
 ②history of past illness :
– whooping cough , measles pneumonia ,
chronic recurrent pulmonary infections in
childhood
 ③X-ray orCT
– tram-lineor parallel lines; 'signet ring' sign
6 COMPLICATIONS

–recurrent pneumonia,
–lung abscess,
–hemoptysis,
–pneumothorax,
–cor pulmonale,
7 TREATMENT

Therapy has two major goals:

(1) improved clearance of

tracheobronchial secretions;
(2) control of infection, particularly
during acute exacerbations;
Antibiotics

 infection plays a major role in

causing and perpetuating
bronchiectasis
 Although choice of an antibiotic
may be guided by Gram's stain and
culture of sputum, empiric
coverage is often given initially.
 empiric coverage :e.g., with ampicillin,
amoxicillin, trimethoprim, newer
macrolides or cefaclor
 mild cases: oral therapy with
quinolone , ampicillin, amoxicillin
 acute exacerbation cases: When
Pseudomonas aeruginosa is present ,
need intravenous therapy with an
aminoglycoside or third-generation
cephalosporin
 Bronchodilators

 Airway reactivity, is often present in

patients with bronchiectasis.
 used to improve obstruction and aid
clearance of secretions
 ß2-adrenergic agonists: inhale β2-agonists
 aminophylline : the dose of the beginning is
100 mg twice daily
Physical Therapy

The objective of physical therapy is to move

excessive secretions, it involves:

① Chest percussion techniques: 3 to 4 times

daily , 1 to 2 minutes per session ,

② head-down positioning : 3 to 4 times daily ,

15 to 30 minutes per session ,
Surgery
 Surgery was once considered to be the main
way to cure the disease but in most cases it
proved ineffective.
 Furthermore, extensive chest surgery itself
often led to atelectasis in the remaining lung
during the postoperative phase, resulting in
further lung damage

 However, surgery remains an option for

persistent and extensive haemoptysis , this
complication can be life-threatening.
 localization of the bleeding to a single lobe
or segment by bronchoscopy can result in a
curative operation.
END