Medical history (history of illness) represents an important component in the diagnosis of bronchiectasis. Family history Is there a history of frequent lung disease in your family? Are there any respiratory diseases in your family that are common? Social history Current medical history/systemic history (somatic and psychological complaints). Did you suffer from frequent respiratory infections … Bronchiectasis: Medical History
Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99). Defective ENaC protein – mutation in the ENaC gene resulting in a defective epithelial sodium channel; hyperactive sodium channel occurs, leading to disruption of salt-water homeostasis (homeostasis = balance) at the respiratory mucosa (bronchial mucosa) Kartagener syndrome – congenital disorder; triad of situs inversus viscerum (mirror-image arrangement of … Bronchiectasis: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by bronchiectasis: Respiratory system (J00-J99) Bronchopleural fistula Pulmonary abscess (encapsulated collection of pus in the lungs). Pleural empyema – accumulation of pus (empyema) within the pleura). Pneumonia (pneumonia) Cardiovascular system (I00-I99) Cor pulmonale – dilatation (widening) and/or hypertrophy (enlargement) of the … Bronchiectasis: Follow-up
Pathogenesis (development of disease) Repeated severe bronchial infections in childhood, such as pneumonias (lung infections), lead to remodeling of the structure of the bronchi. Bronchiectasis also often begins with narrowing (obstruction) of the bronchial tree, such as by foreign bodies or bronchial tumors. Ultimately, most triggers result in destruction of the respiratory ciliated epithelium and … Bronchiectasis: Causes
General measures “Bronchial toilet” (daily) – the bronchi become better ventilated again and infections are prevented (can take up to an hour): Liquefaction of bronchial mucus by inhalation with secretolytics (mucolytic cough suppressants). Loosening the mucus by tapping the back and thorax (chest). Coughing up the secretions; a special posture can facilitate coughing: Knee-elbow position … Bronchiectasis: Therapy
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore: Inspection (viewing). Skin, mucous membranes and sclerae (white part of the eye). Finger Drumstick fingers? [the end links of the fingers are distended like pistons]. Watch glass nails? … Bronchiectasis: Examination
1st order laboratory parameters – obligatory laboratory tests. Microbiologic examination of sputum [standard diagnostics] – for antibiotic regimen selection and follow-up. Common pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus. Immunoglobulins (group of proteins (protein) formed in plasma cells and specifically bind as antibodies with foreign substances (antigens) to render them harmless): IgE – for the … Bronchiectasis: Lab Test
Therapeutic targets Treatment of the underlying disease, if applicable. Symptomatic therapy: Secretolytic therapy – dissolving the viscous secretions in the bronchi (secretion drainage). Anti-infective measures (directed against infection (with microorganisms)). Antiobstructive therapy (directed against narrowing of the airways). Treatment of chronic inflammation (inflammation). Avoidance or reduction of exacerbations (disease relapses). Prevention of infections Improvement of … Bronchiectasis: Drug Therapy
Obligatory medical device diagnostics. High-resolution thin-slice computed tomography (HRCT) – allows diagnosis at earlier stages of disease; most reliable diagnostic tool for detecting bronchiectasis. Bronchoscopy (pulmonary endoscopy) – to obtain material in progression (progression) of the disease with recurrent episodes of disease and negative sputum findings; pathogen diagnostics: mycobacteria (tuberculosis)?; bronchial stenosis (narrowing of the … Bronchiectasis: Diagnostic Tests
In severe cases, bronchiectasis can be surgically removed. Either only a lung segment (segment resection) or a complete lobe of the lung (lobectomy) is removed. Indications: Unilateral and localized bronchiectasis Threatening hemoptysis (hemoptysis) Insufficient success of conservative therapeutic measures. Benefit: Resection increases symptom freedom. Complications: Atelectasis (collapse of alveoli). Bronchopulmonary fistulas Postpartum hemorrhage Pneumonia (inflammation … Bronchiectasis: Surgical Therapy
The following symptoms and complaints may indicate bronchiectasis: Pathognomonic (indicative of disease). Increase in sputum production (sputum = sputum) – especially in the morning after changing position; “mouthful” “Three-layer sputum“: foamy upper layer, mucous middle layer, viscous sediment with pus (Latin pus, Greek πύον pyon). Odor: sweetish foul; color: green-yellowish. The sputum may contain blood … Bronchiectasis: Symptoms, Complaints, Signs
