Bronchiectasis

– DDB or bronchiectasis is anatomically defined by an abnormal and irreversible dilatation of bronchial caliber associated with a destruction of the adjacent lung parenchyma.

– The bronchial mucosa is the site of significant inflammation, leading to hypertrophy of mucous glands and goblet cells => bronchial hypersecretion. There is stasis of mucus favored by the deterioration of hair cells; it establishes a chronic infection of the bronchi (vicious circle); these lesions may be diffuse or localized.

– The bronchi end in cul-de-sac with obliteration of the small airways in swallow.

– An obstructive syndrome is common but it is often associated with a restrictive syndrome => mixed syndrome.

– There neovascularization from the bronchial arteries may be responsible for hemoptysis.

I- etiological factors:

A- Dilatation diffuse bronchial:

1- Birth defects:

– Kartagener syndrome * (illness immobile cilia)

– Cystic Fibrosis

– Immunodeficiency

2- acquired abnormalities:

– Severe infections of infancy (pertussis, measles, RSV, adenovirus)

– System diseases (rheumatoid arthritis).

B- localized dilation of the bronchi:

1- sequelae of tuberculosis:

– Tuberculosis disease => upper lobe

– The Brock syndrome (nd middle lobe) with calcified hilar ADP, bronchial stenosis and DDB middle lobe (PIT?)

2- bronchial stenosis:

– Foreign body

– Lung tumor

– McLeod syndrome

– Allergic Aspergillosis **

* Sinusitis, DDB, sterility and situs inversus.

** Combines chronic asthma and DDB proximal

II- diagnosis:

– Clinical features: daily sputum, permanent, abundant; hemoptysis are common; dyspnea varies depending on the extent of the injuries.

– Clubbing is usual and evocative; auscultation found rattling

– Chest X-ray: can show several aspects (may be normal)

* Thickening tubular or annular bronchial walls (walls sectional views) cystic image

* Images cystic rounded juxtaposed identified a thin opaque rim and sometimes liquid levels

* Retractile opacities systematized, band (disturbance of ventilation)

* Images often predominated in regions postérobasales

– The CT scan of the chest is fundamental (to confirm the diagnosis)

– Indications for bronchographie is limited to preoperative assessments, and the rare cases where the scanner is not conclusive.

III- Assessment of the disease (impact):

– EFR: joint syndrome (obstructive and restrictive). The severity is correlated with the decline in FEV; FEV <30% predicted a pejorative prognostic value.

– Blood Gas: at the stage of IRC, there is a hypoxia with hypercapnia

IV- Treatment:

– Physiotherapy is fundamental, it is the basis for chronic care; Daily active sessions.

– Antibiotic therapy is systematically adapted to the germ: fluoroquinolones (Haemophilus influenzae); in case of infection with Pseudomonas aeruginosa, an intravenous combination is recommended (ß-lactams and aminoglycosides).

– The identification of a reversible obstructive syndrome is common and encouraged to prescribe bronchodilators for long periods.

– Oxygen therapy long-term is necessary in advanced cases with chronic respiratory failure and severe hypoxemia.

– Surgical treatment: in localized forms so frequent complications (infections, hemoptysis) => segmentectomy or lobectomy.