Bronchiectasis

Bronchiectasis

The lower lobes are typically affected by chronic dilatation of the bronchi and bronchioles caused by inflammation and thinning of their walls.

Etiology

• Respiratory infection
• Bronchial obstruction
• Foreign bodies being aspirated.
• Vomitus.
• Lungs' upper respiratory tract materials.
• Common causes include immunodeficiency.

Clinical Manifestation

• Finger clubbing.
• Persistent fever
• Rhonchi and crackles
• A protracted cough that is productive and produces a lot of purulent sputum.
• Irregular hemoptysis
• Breathlessness.

Pathophysiology

By weakening or destroying the muscular and elastic components of the bronchial walls, bronchiectasis is characterized by an abnormal enlargement of the proximal and medium-sized bronchi (>2 mm in diameter). Different alterations, such as transmural inflammation, edema, scarring, and ulceration, among others, may be present in affected locations. Additionally, chronic microbial infections and frequent post-obstructive pneumonia may harm the distal lung parenchyma. Though it can be inherited, bronchiectasis is more frequently acquired. [9]

Infants and children are typically affected by congenital bronchiectasis. The bronchial tree's development has been stopped in these circumstances.

Adults and older children can develop acquired forms, which call for an infectious insult, poor drainage, airway blockage, and/or a weakness in the host's immune system. The host's reaction to neutrophilic proteases, inflammatory cytokines, nitric oxide, and oxygen radicals also contributes to some degree to tissue injury. The bronchial wall's elastic and muscular components are damaged as a result. Diffuse peribronchial fibrosis may also arise from harm to an alveolar tissue in the peribronchial region. [12]

As a result, there is transmural inflammation, aberrant bronchial dilatation, and bronchial wall disintegration. The clearance of secretions from the bronchial tree is substantially hindered, which is the most significant functional finding of altered airway structure.

Impaired secretion clearance leads to pathogenic organism colonization and infection, which contributes to the purulent expectoration frequently seen in bronchiectasis patients. As a result, there is more bronchial injury, bronchial dilatation, reduced secretion clearance, recurrent infection, and additional bronchial damage.

Diagnostic Evaluation

• A chest x-ray.
• Sputum analysis.
• A CT scan

Management

Infection is controlled by

• Giving up smoking
• Anti-microbial therapy
• Immunization.
• Postural evaporation
• Medications.
• Resection via surgery.
• Therapy for the chest.

Nursing Management

• Encourage the exercise for your chest.
• Encourage them to drink more water.
• Provide humidification
• Avoid noxious smells, smoke, dust, etc.
• Observe sputum.
• Routine dental visits.
• Inhale steam to moisten the bronchial tree.
• Encourage high-protein foods to support a healthy lifestyle and tissue repair
• Drink a lot of liquids to encourage expectoration.
• The patient should learn to drain all secretions.
• Verify the sputum's quantity, color, and characteristics.