Bronchiectasis : Its Proper Management

 

By Brig. Dr. J. S. Bhalla (Retd.)

M.B.B.S., D.C.D., M.D., (Gen. Med.), F.C.C.P.,(U.S.A.)

Fellow International Academy of Chest Physicians & Surgeons (U.S.A.)

Consultant Physician at Santokh Nursing Home, 846 Sec 38 A, Chandigarh.

 

Description:

Persistent, irreversible, abnormal dilatation of the bronchi, usually accompanied by infection. Associated with many conditions including some that are congenital and hereditary. Its usual course is chronic.

 

Causes:

Congenital – 1) Ciliary dysfunction syndromes,

2) Cystic fibrosis

3) Primary hypo-gamaglobulinaemia.

Acquired – 1) Children – Pneumonia, Pertussis, Measles, Bronchiolitis

2) Adults – Suppurative Pneumonia, Pulmonary Tuberculosis.

 

Pathology:

Bronchiectatic cavities may be lined by granulation tissue, squamous epithelium. There may also be inflammatory changes in the deep layers of the bronchial wall & hypertrophy of bronchial arteries. Chronic inflammatory changes and fibrotic changes are usually found in the surrounding lung tissue.

 

Symptoms & Signs:

A) Due to accumulation of pus in dilated bronchi;

Chronic productive cough, usually morning coughing and postural cough. Quantity of sputum is generally large and purulent in advanced diseases;

Usually putrid smell is there in the sputum, which settles in layers on keeping in conical glass.

B) Due to inflammatory changes in the lung and pleura surrounding dilated bronchi: fever, malaise, increased cough and sputum. Recurrent pleurisy on the same side as brochiect pneumonia, chest pain and increased sputum.

C) Haemoptysis: Often recurrent; can be slight or massive; usually associated with purulent sputum. Streaky haemoptysis or more may be the only symptom of “Brochiectasis Sicca” (Dry Brochiectasis). D) General: Weight loss, lassitude, anorexia, sleep sweating. And failure to thrive in children. Mostly due to recurrent infections and copious purulent expectoration. Nails are usually clubbed.

Signs: clubbed nails, barrel chest, emaciation, cyanosis, dyspnoea, orthopnoea, tachypnoea, coarse crepitations with or without accompanying rhonchi, pleural frictions or signs of collapse/collapse consolidation. Halitosis

 

Diagnosis: History of childhood exanthemata, recurrent respiratory infections in non-thriving children. Chronic cough, dyspnoea and copious expectoration, muco-purulent, with putrid smell and the above noted signs should help diagnose specially if recurrent pleurisy or recurrent haemoptysis are there.

 

Differential Diagnosis: Chronic Brochitis/ COPD, cystic fibrosis, pulmonary TB

 

Investigation:

1) Bacterial and mycological examination of sputum in all cases specially when treated repeatedly on antibiotics.

2) Radiological Examination. Conventional X-Ray of chest PA and apical view only when advanced disease is there.

Abnormality is established with certainty by Brochography – carefully done only on one side at a time with aqueous contrast solution. Particularly when surgery is contemplated and Respiratory functions are optimal.

3) CT SCAN – It is less sensitive for diagnosing Bronchiectasis in children. High resolution scans, Ultrafast scans are best for children.

4) Fibre Optic Brochoscopy: when disease is recent in origin and unilateral, it is recommended. FOB is combined with brochoscopy and specimens obtained for culture.

5) Assessment Of Ciliary Functions – Screening test are rarely done these days.

 

Special Tests:

1) Skin test for aspergillus.

2) Bronchoscopy is useful to locate the site of bleeding, to locate foreign body or to exclude adenomata.

3) Ciliary Biopsy for electron Microscopy.

4) Pulmonary Function Tests.

5) Sputum Culture & ABST.