2. This young man has long history of productive cough and wheezing. He is afebrile and chest auscultation reveals coarse crackles at right lower chest This young man has long history of productive cough and wheezing. He is afebrile and chest auscultation reveals coarse crackles at right lower chest

3. BRONCHIECTASIS

4. Bronciectasis (Greek word) Bronciectasis (Greek word) Bronkos ---- Wind pipeBronkos ---- Wind pipe Ektesis ---- StretchingEktesis ---- Stretching

5. HOW DO YOU DEFINE BRONCHIECTASIS ?

6. Abnormal and permanent dilatation of bronchi and bronchioles greater than 2 mm BRONCHIECTASIS

7. CLASSIFICATION REID’S CLASSIFICATION (1950) REID’S CLASSIFICATION (1950) Based on Pathology & BronchographyBased on Pathology & Bronchography Cylindrical Cylindrical Varicose Varicose Saccular (Cystic) Saccular (Cystic)

10. Sacular type Cylindrical Sacular type Cylindrical

11. Varicose Type Varicose Type

16. MUCOUS PLUGS DILATED BRONCHIOLE

17. PATHOGENESIS

18. BRONCHIAL INSULT NORMAL HOST RESPONSE TO BRONCHIAL INSULT INFLAMMATION MUCOCILLIARY CLEARENCE RETURN TO HEALTH

19. BRONCHIAL INSULT ABNORMAL HOST RESPONSE TO BRONCHIAL INSULT INFLAMMATION IMPAIRED MUCOCILLIARY CLEARENCE BRONCHIAL OBSTRUCTION BRONCHIAL DAMAGE FURTHER INFLAMMATION BRONCHIECTASIS

20. PATHOGENESIS OBSTRUCTION OBSTRUCTION INFLAMMATION INFLAMMATION

21. ETIOLOGY OF BRONCHIECTASIS Congenital Acquired

22. Case Study While doing clinical elective in UK, you happen to see a young man, who has been regularly visiting chest clinic since birth with multiple admissions. He c/o productive cough and shortness of breath. His brother also suffers from the same disease. His chest x-ray is While doing clinical elective in UK, you happen to see a young man, who has been regularly visiting chest clinic since birth with multiple admissions. He c/o productive cough and shortness of breath. His brother also suffers from the same disease. His chest x-ray is

23. What is the diagnosis ? What is the diagnosis ? What is mode of inheritance ? What is mode of inheritance ? What do you see on this chest x-ray. What do you see on this chest x-ray. What is pathology What is pathology

24. CYSTIC FIBROSIS What is the diagnosis ? What is the diagnosis ? What is mode of inheritance ? What is mode of inheritance ? What do you see on this chest x-ray. What do you see on this chest x-ray. What is pathology What is pathology

25. Case Study 30 Years old gentleman comes to you with chronic sinusitis and productive cough. His x-ray of sinuses and chest are

26. What is the diagnosis ?

27. Kartageyner Syndrome

28. Primary ciliary dyskinesia (PCD) or Kartagener Syndrome (KS), is a rare, ciliopathic, autosomal recessive gene tic disorder that causes a defect in the action of the cilia lining the respiratory tract (lower and pper, sinuses, Eustachian tube,middle ear) and fallopian tube.ciliopathicautosomalrecessivegene tic disorderciliarespiratory tractsinusesEustachian tubemiddle earfallopian tube

29. Kartageyner Syndrome It is combination of Ciliary Dyskinesia and situs inversus (complete or incomplete) It is combination of Ciliary Dyskinesia and situs inversus (complete or incomplete) Infertility Infertility

30. What are the congenital causes of Bronchiectasis ?

31. ETIOLOGY: CONGENITAL Cystic Fibrosis Cystic Fibrosis Primary Ciliary Dyskinesia Primary Ciliary Dyskinesia Kartagener’s Syndrome Kartagener’s Syndrome Immunodeficiency States Immunodeficiency States Intralobular Lung Sequestration Intralobular Lung Sequestration

32. AQUIRED CAUSES POST INFECTIOUS POST INFECTIOUS BRONCHIAL OBSTRUCTION BRONCHIAL OBSTRUCTION MISCELLANEOUS CONDITIONS MISCELLANEOUS CONDITIONS

33. AQUIRED CAUSES POST INFECTIOUS Bacterial Bacterial Mycobacterium tuberculosis Mycobacterium tuberculosis Pseudomonas aureginosa Pseudomonas aureginosa Hemophillus influenzae Hemophillus influenzae Staphylococcus aureus Staphylococcus aureus

35. AQUIRED CAUSES: POSTINFECTIOUS Viral Viral Adenovirus Adenovirus Influenza Influenza HIV HIV Fungal Fungal Aspergillus fumigatus (ABPA) Aspergillus fumigatus (ABPA)

36. Allergic Bronchopulmonary Aspergillosis (ABPA) Mainly in Asthmatics Mainly in Asthmatics Sensitization to aspergillous Sensitization to aspergillous Raised IgE level Raised IgE level Tubular Bronchiectasis Tubular Bronchiectasis

38. ETIOLOGY : BRONCHIAL OBSTRUCTION Tumour Tumour Foreign Bodies Foreign Bodies Mucous Plugs Mucous Plugs

39. ETIOLOGY: ETIOLOGY: OTHER CAUSES Rheumatoid Arthritis Rheumatoid Arthritis Inflammatory Bowel Disease Inflammatory Bowel Disease Systemic Lupus Erythematosus Systemic Lupus Erythematosus Post transplant Post transplant

40. CLINICAL PRESENTATION SYMPTOMS SYMPTOMS Persistent cough Persistent cough Purulent sputum Purulent sputum (green and foul smelling) (green and foul smelling) HemoptysisWET TYPE HemoptysisWET TYPE Dyspnea Dyspnea Wheeze Wheeze Fever Fever Severe Pneumonia Severe Pneumonia AsymptomaticDRY TYPE AsymptomaticDRY TYPE Non Productive Cough Non Productive Cough

41. CLINICAL PRESENTATI0N SIGNS SIGNS On GPEOn GPE Digital Clubbing Digital Clubbing Cyanosis Cyanosis Plethora Plethora Muscle wasting Muscle wasting On AuscultationOn Auscultation Crackles Crackles Wheeze Wheeze Ronchi Ronchi

42. COMPLICATIONS Recurrent pneumonia Recurrent pneumonia Empyema Empyema Haemoptysis Haemoptysis Pneumothorax Pneumothorax Lung abscess Lung abscess Brain abscess Brain abscess Amyloidosis Amyloidosis Cor pulmonale Cor pulmonale

43. DIAGNOSIS CLINICAL PRESENTATION CLINICAL PRESENTATION SPUTUM ANALYSIS SPUTUM ANALYSIS RADIOLOGY RADIOLOGY DIRECT VISUALISATION DIRECT VISUALISATION ESTABLISHMENT OF CAUSE ESTABLISHMENT OF CAUSE

44. CLINICAL PRESENTATION HISTORY HISTORY CLINICAL EXAMINATION CLINICAL EXAMINATION RULE OUT RULE OUT Pneumonia Pneumonia Emphysema Emphysema Lung abscess Lung abscess

45. SPUTUM ANALYSIS Amount of sputum Amount of sputum 24 hr Sputum Production 24 hr Sputum Production Mild< 10 ml/day Mild< 10 ml/day Moderate<150 ml/day Moderate<150 ml/day Severe>150 ml/day Severe>150 ml/day Visual Impression Visual Impression Microbiology Microbiology Streptococcus pneumoneae Streptococcus pneumoneae Hemophillus influenzae Hemophillus influenzae Aspergillus Aspergillus Psedomonas Psedomonas E. coli E. coli

46. LAB TESTS Blood complete picture Blood complete picture Quantitative immunoglobulin Quantitative immunoglobulin Alpha-1 anti-trypsin level Alpha-1 anti-trypsin level

47. RADIOLOGY Chest X-ray PA view Chest X-ray PA view Cylindrical Cylindrical Varicose Varicose Saccular Saccular Bronchography Bronchography CT Scan CT Scan

50. DIRECT VISUALISATION Bronchoscoy Bronchoscoy Flexible Flexible Rigid Rigid

51. ESTABLISHMENT OF CAUSE Serum Protein electrophoresis Serum Protein electrophoresis Serum Immunoglobulins Serum Immunoglobulins Pilocarpine Iontophoresis (Sweat Test) Pilocarpine Iontophoresis (Sweat Test) Aspergillus Precipitin Test Aspergillus Precipitin Test Electron Microscopy Electron Microscopy

52. MANAGEMENT 4 GOALS 4 GOALS Elimination of Problem Elimination of Problem Clear Tracheo-bronchial Secretions Clear Tracheo-bronchial Secretions Control Infections Control Infections Reverse Airflow Obstruction Reverse Airflow Obstruction

53. MANAGEMENT POSTURAL DRAINAGE POSTURAL DRAINAGE BRONCHODIALATORS BRONCHODIALATORS CORTICOSTEROIDS CORTICOSTEROIDS

54. TREAT INFECTIONS Antibiotics (according to C&S) Antibiotics (according to C&S) Amoxicillin 250mg -------- TDS Amoxicillin 250mg -------- TDS Co-amoxiclav 325mg -------- TDS Co-amoxiclav 325mg -------- TDS Levofloxacin 500mg -------- BD Levofloxacin 500mg -------- BD Ceftazidime Ceftazidime Preventive and suppressive antibiotics Preventive and suppressive antibiotics

55. Other treatment Inhaled Broncho dilators Inhaled Broncho dilators Inhaled aerosolized aminoglycosides Inhaled aerosolized aminoglycosides

57. Surgery Reserved for patients with localised bronchiectasis and adequate lung functions Reserved for patients with localised bronchiectasis and adequate lung functions Sometime in massive haemoptysis Sometime in massive haemoptysis

58. PREVENTION VACCINATION VACCINATION Influenza vaccine Influenza vaccine Pneumococcal vaccine Pneumococcal vaccine AVOID EXACERBATING FACTORS AVOID EXACERBATING FACTORS Regular chest physiotherapy Regular chest physiotherapy

59. Stay together