Bronchiectasis are chronic inflammatory disease of bronchi and bronchioli. It is characterized by pathologic and radiologically by permanent stretching of bronchi and bronchials (diameter> 2mm). In the pathogenesis of bronchiectasis, the mobilization of a vicious cycle of “infection-inflammation” plays a critical role that makes weak infertile infections.

Bronchiectasis are distinguished in:

  • Congenital mostly occurring in infants and children
  • Acquired occurring in adolescents and adults

Rationale

1. Airway blockage: Foreign body aspiration, lung malignancy or lymphadenopathy
2. Immunodeficiency-hypogammammammopathy-proven immunosuppression-AIDS
3. Cystic fibrosis: Usually diagnosed in childhood. 7% of patients with cystic fibrosis is diagnosed at the age of 18 years.
4. Young Syndrome: Patients develop sinusitis, bronchiectasis and azoospermia.
5. Structural changes in the lung:

-themiamalia (Mounier-Kuhn’s Syndrome)

-Brochomagia (Williams-Campbell Syndrome)

6. Rheumatic diseases: rheumatoid arthritis and Sjogren’s disease. In rheumatoid arthritis, bronchiectases may be preceded. Ulcerative colitis. Yellow nail syndrome
7. Crusader Dyskinesia Syndrome and Kartagnuer Syndrome
8. A1 A1 deficiency
9. Pulmonary infections in childhood, mainly viral (pertussis), mycoplastic pneumonia and prolonged bronchitis> 4 weeks

Diagnosis

The confirmation of the diagnosis of bronchiectasis is done by high -resolution computed tomography.

Blood tests such as born Blood, CRP, TKE, quantitative identification of immunoglobulin-colllagon control is performed to determine the cause of bronchiectasis.

Spirometry where a obstructive syndrome is usually found with or without response to bronchodilation.

In acute exacerbation of bronchiectasis, all patients should undergo sputum cultivation to detect the causal factor, often responsible germs are: influenza hemophilic, moraxella, golden staphylococcus and pseudomonas.

Patients should also be undergoing a test for the detection of influenza A and B, COVID 19 and other viruses.

Bronchoscopy is done in patients with haemoptysis and accordingly pulmonary angiography

Treatment

Respiratory physiotherapy:

  • mucosal agents (hypertensive saline with nebulization)
  • inhaled bronchodilators mainly in patients with obstructive syndrome in spirometry and reversibility in bronchodilation
  • treatment
  • control of infections

Frequent exacerbations are the strongest predictor.

A series of antibiotics have been studied to reduce the frequency of exacerbations (macrolides: azithromycin) for a duration of 6 to 12 months.

Inhaled antibiotic (Tobramycin-Colistine) for patients with frequent exacerbations> 3 per year and mainly with pseudomonas aeruginosa on sputum

Surgery In specific indications

Prevention

  • Annual Anticiptic Embolism-Brand against Pneumonian and Covid 19 and RSV.
  • Avoiding smoking and inhalation of irritants.
  • Natural rehabilitation