Bronchiectasis
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Definition
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Bronchiectasis is an obstructive lung disease that results from the presence of chronic inflammatory secretions and microbes leading to the permanent dilation and distortion of airway walls, as well as recurrent infection Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Mechanism of Injury / Pathological Process
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Bronchiectasis is chronic irreversible dilation of the bronchi on the lungs. It follows a severe lung infection or aspiration. It is more common in conditions such as Cystic Fibrosis, Rheumatoid Arthritits, Immunodeficiency, Young's syndrome and Allergic Bronchopulmonary Aspergillosis, and after chilhoos diseases such as whooping cough, TB and measles.
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Clinically Relevant Anatomy [edit | edit source]
Bronchiectasis involves inflammation of the airway walls, specifically the bronchial walls Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The airway walls are the ‘tubes’ that run from the mouth and nose and travel to the lung. The main area that is affected in bronchiectasis is the bronchi Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The trachea bifurcates into the right and left main bronchi, which then further divide into secondary bronchi; one for each lobe of the lung Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. They then divide into tertiary bronchi; one for each bronchopulmonary segment Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
The cilia are also damaged in bronchiectasis. Cilia line the airway and are attached to the epithelium. They are hair-like with tiny hooks on the tip to grab the mucous and help move the mucous up to the throat Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Epidemiology
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It is underestimated in prevalence, incidence and morbidity because symptoms are often ascribed to smoking. A study by Hill Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titlefound that one in 1000 Britons have bronchiectasis, with associated deaths increasing at a rate of approximately 3% per year in England and Wales Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Though the overall mortality rate is increasing in these countries, rates in older groups are rising whereas rates in younger groups are falling Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. A disproportionate amount of cases found in developing countries and in Aboriginal populations in affluent communities Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. In some populations, an improvement in socio-economic status, housing and education can improve overall health and reduce the incidence of respiratory infection and development of bronchiectasis Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Aetiology[edit | edit source]
The cause is unknown for 50% of cases, but it has been linked to inflammatory bowel disease, rheumatoid arthritis, and in 29-50% of patients, COPD Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. There are several associated conditions with bronchiectasis including; cystic fibrosis, primary ciliary dyskinesia, lung tuberculosis, allergic bronchopulmonary aspergilosis, rheumatoid diseases, symptomatic lupus erythematosus, immune deficiency, severe childhood respiratory infection and exposure to foreign body or corrosive substance Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. It has also been linked to an x1-antitrypsin deficiency Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. Bronchiectasis tends to predispose patients to acquired and congenital lung infections Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Pathophysiology[edit | edit source]
The process begins with inflammatory damage to the bronchial walls, which then stimulates the formation of excess thick mucus Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The warm and moist environment of the lungs combines with the mucus to cause further inflammation and obstruction, creating an excellent environment for infection Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title. The thick mucus crushes the cilia and causes further damage. The immune response releases toxic inflammatory chemicals (i.e. neutrophils), as well as leads to fibrosis and bronchospasm if persistentCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title.
Differential Diagnosis
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Key Evidence[edit | edit source]
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Resources
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