Bronchiectasis

One Priamita Intansari I11108048

Anatomi

Categories of Respiratory Disease

Definition
The term bronchiectasis is derived from the Greek words bronkia (bronchial tubes), ek (out), and tasis (stretching), which together literally mean the outstretching of the bronchi. The condition is generally defined as an abnormal and permanent dilatation of the cartilage-containing airways (bronchi).

 Bronchiectasis refers to an irreversible airway dilation that involves the lung in either a focal or a diffuse manner and that classically has been categorized as cylindrical or tubular (the most common form), varicose, or cystic.

Prevalence
The true prevalence of bronchiectasis is unknown for most regions of the world.

Etiology

 The main bacterial pathogens that are commonly isolated are Haemophilus influenzae (29%70%) followed by Pseudomonas aeruginosa (12%31%). Additional microorganisms that may be encountered include Streptococcus pneumoniae, Haemophilus parainfluenzae, Staphylococcus aureus, and Moraxella catarrhalis.

Patogenesis
The most widely cited mechanism of infectious bronchiectasis is the "vicious cycle hypothesis, by Professor Peter Cole, proposed that an initial airway insult, such as an infection, often on the background of genetic susceptibility, compromised host clearance mechanisms and, in particular, the mucociliary escalator mechanism, which facilitated persistent bacterial colonization and infection.

Patology
Classic studies of the pathology of bronchiectasis from the 1950s demonstrated significant smallairway wall inflammation and larger-airway wall destruction as well as dilation, with loss of elastin, smooth muscle, and cartilage.

Clinical Manifestations
A persistent productive cough with ongoing production of thick, tenacious sputum. Hemoptysis Chest pain, Dyspnea, Decreased effort tolerance;

Physical Finding
Crackles and wheezing in the lung auscultation Clubbing of the digits

 Classical clinical triad:

Chronic cough Excess sputum production Repeated infection

 Sputum examination - identification of a pathogen and characterization of its antimicrobial susceptibility pattern would aid in decisions regarding antibiotic therapy.

Radiographic
Interpretation : Ring opacities on both of lung like honeycomb appearance

High-Resolution CT (HRCT) scaning of the chest

High-resolution CT (HRCT) scanning of the chest, which has become the gold standard for the diagnosis; The most specific HRCT scanning findings suggestive of bronchiectasis are: 1. Interrnal diameter of the bronchus is wider than the adjacent pulmonary artery (ie, signet ring formation), 2. Failure of the bronchi to taper, and 3. Bronchi being visualized in the outer 1 to 2 cm of the lung fields.

High-Resolution CT (HRCT) scaning of the chest

Severe cystic bronchiectasis in the right lower lobe of an adult patient, demonstrated with HRCT scan of the chest.

Therapy
General health measures such as adoption of good nutrition, non-smoking strategy, regular exercise, and exposure to fresh air. Mobilization of Airway Secretions
Chest physiotherapy such as postural drainage
Mucolytics and inhaled hyperosmolar agents

Therapy (2)
Bronchodilator Antibiotic - commonly for between 7 and 14 days. Antiinflammatory
Corticosteroid - indicated for use in patients with bronchiectasis for associated asthma, COPD, or airway hyperreactivity. Macrolides - have significant effects on the mucociliary clearance mechanism through effects on ciliated airway epithelium and on mucus production and quality.

Surgery
Specific surgical indications include :
1. Life-threatening conditions, such as hemoptysis, 2. Localized disease causing severe symptoms, which are nonresponsive to medical therapy, 3. Resectable disease causing persistent focal infection, and 4. Localized resectable disease with failure to thrive.

Prevention
Influenza vaccination - is widely recommended for use in both groups (child and adult) of patients, in adults in particular because of a reduction in exacerbations in patients with COPD, many of whom have coexistent bronchiectasis.

Prognosis
Bronchiectasis morality appears to be up to 13% over a 5-year follow-up period and patients of older age with chronic hypoxia, hypercapnia, and greater radiological extent of the disease appear to be most vulnerable.

Complication
Microbial resistance to antibiotics. Recurrent infections can result in injury to superficial mucosal vessels, with bleeding and, in severe cases, life-threatening hemoptysis.

THANK YOU

 Charles Feldman, Bronchiectasis: New Approaches to Diagnosis and Management, Clin Chest Med 32 (2011) 535 546 Longo, Dan. L, Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Stephen L. Hauser and Joseph Loscalzo, Principle Of Internal Medicine 18th ed. Bronchiectasis and Lung Abscess. United State Of America: McGraw-Hill Companies, 2012 Sudoyo, Aru W, Bambang Setiyohasi, Idrus Alwi, Marcellus Simadbrata K and Siti Setiati. Buku Ajar Ilmu Penyakit Dalam. In: pasiyan Rahmatullah, editor. Bronkiektasis. Jakarta: Departemen Ilmu Penyakit Dalam; 2007. p. 10351039.