BRONCHIECTASIS

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A condition in which the lungs’ airways become damaged, making it hard to clear mucus.Bronchiectasis may result from an infection or medical condition, such as pneumonia or cystic fibrosis. Mucus builds up and breeds bacteria, causing frequent infections.

BRONCHIECTASIS

Essentials of Diagnosis:-

• Chronic cough with profuse, purulent sputum.
• Bilateral basal coarse crepitations with rhonchi.
• Clubbing of fingers, haemoptysis.
• Signs of general toxaemia, e.g. anaemia, anorexia,
weight loss, etc.
• Pulmonary osteoarthropathy, varying degree of
dyspnoea.
• Sputum production is more during change of
posture. Sputum often separates into three layers,
i.e. sediment, fluid and foam on standing.
• Plain X-ray chest shows increased pulmonary
markings at bases with multiple radiolucencies.
• Bronchogram shows saccular, cylindrical or fusiform dilatations with loss of normal “tree in full bloom
pattern” of the terminal bronchi.

Investigation:-

-Chest x ray

-CT chest

Your initial evaluation will likely include:

  • CBC
  • immunoglobulin levels (IgG, IgM, and IgA)
  • Sputum culture to check for bacteria, mycobacteria, and fungi

Treatment:-

-Bed rest.
-Avoid exposure to smoke, dust, fumes.
-Warm, dry climate is preferable.
-Mucolytic agents, i.e. acetylcysteine by aerosol to liquify thick sputum.
-A hot drink before postural drainage may help to liquify sputum. Attempts to dislodge the secretions should be made by coughing and by percussing the affected part of the chest. Drainage should be done for 10 minutes.
Ampicillin 500 mg four times daily or Septran DS twice daily.

Adequate nutrition.


Indications for surgical resection are:


-Unilateral bronchiectasis with more than 1 ounce of sputum in 24 hours.
-Repeated major infections in bronchiectatic area.
-Young adults.
Contraindications of surgery are:
-Old age.
-Poor cardiorespiratory reserve.

-Bilateral extensive disease.

Other antibiotics
-Ciprofloxacin 500 mg twice daily. or
Pefloxacin 400 mg twice daily.
To be continued till sputum becomes mucoid.
If acute infection does not subside or recurs quickly
culture sputum and prescribe antibiotic as per sensitivity

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