Bronchiectasis (Obstructive) Cheat Sheet by kissmekate

Pathop­hys­iology

• Permanent, abnormal dilation and destru­ction of the bronchial walls. Cilia are damaged.
• Onset is usually early in childhood. Infection in a patient with airway obstru­ction or impaired defense or drainage mechanism precip­itates the disease.
• Cause is identified in fewer than half of patients. Less common today due to modern antibi­otics.

Symptoms

• Chronic cough with large amounts of mucopu­rulent, foul-s­melling sputum.
• Rhino sinusitis. Dyspnea, pleurisy, wheezing, crackles, clubbing.
• Hemoptysis due to rupture of blood vessels near bronchial wall surfaces; usually mild and self-l­imited but sometimes can be brisk and present as an emergency.
• Recurrent or present pneumonia. More likely to have larger volume of sputum, recurrent fever, hemopt­ysis, and Pseudo­monas than chronic bronch­itis.

Pulmonary Function Tests

• Obstru­ctive pattern.

Treatment

• Antibi­otics for acute exacer­bations (infec­tions are signaled by change in qualit­y/q­uantity of sputum, fever, chest pain).
• Bronchial hygiene with hydration, chest PT (postural drainage, chest percus­sion) to help remove mucus, and inhaled bronch­odi­lators.
• The goal is to prevent compli­cat­ions.
• Cortic­ost­eroids and macrolide to reduce airway inflam­mation.

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