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[broncho- + ectasis,]
Chronic dilation of a bronchus or bronchi, usually in the lower portions of the lung, caused by the damaging effects of a long-standing infection.
More than 100,000 Americans have bronchiectasis. The prevalence increases with advancing age.
The condition may be acquired or congenital and may occur in one or both lungs. Bronchiectasis has three forms (cylindrical, varicose, and saccular), which may occur individually or together. Acquired bronchiectasis usually occurs secondary to an obstruction or an infection such as bronchopneumonia, chronic bronchitis, tuberculosis, cystic fibrosis, or whooping cough. The incidence has decreased with antibiotic treatment of acute infections.
SYMPTOMS AND SIGNS
Chronic cough, foul-smelling, mucopurulent, or bloody sputum, fever, shortness of breath, wheezing, and malaise are common symptoms and signs.
Radiography is used to confirm the diagnosis. High-resolution lung CT reveals abnormal widening of small and medium-sized bronchi with mucosal thickening.
Lower respiratory infections and lung function in patients with bronchiectasis may be preventable with daily antibiotic therapy.
Therapy consists of oral or IV antibiotics for 7 to 10 days, pulmonary hygiene, and postural drainage. Resection of affected areas may be done in selected patients. Aerosols may be useful for bronchodilation, if bronchospasm is present. In advanced cases of bronchiectasis complicated by chronic respiratory failure, lung transplantation is an option.
SEE: postural drainage
The natural history of bronchiectasis is variable. Some patients have relatively infrequent infectious complications; others may deteriorate rapidly and require ventilatory assistance in an ICU. Mortality is increased in patients infected with Pseudomonas species, and when bronchiectasis is combined with other significant illnesses, such as emphysema, heart disease, or diabetes mellitus.
The patient is assessed for the presence or increased severity of respiratory distress. Ventilatory rate, pattern, and effort are observed, breath sounds are auscultated, and sputum is inspected for changes in quantity, color, or viscosity. The respiratory therapist evaluates gas exchange by monitoring arterial blood gas values and administers oxygen according to protocol or as prescribed. The patient is observed for complications such as cor pulmonale. The patient should increase oral fluid intake and be shown how to use a humidifier or nebulizer to help thin inspissated secretions. He or she is also taught to breathe deeply and cough effectively. Chest physiotherapy is most effective and least disruptive if carried out in the morning, 1 or 2 hr before meals, and at bedtime. The patient is taught to remain in each prescribed position for at least 10 min; then percussion is performed, followed by two-stage coughing to remove secretions. The nurse or respiratory therapist suctions the oropharynx if the patient is unable to clear the airway and teaches the patient and family how to do this. The need for frequent oral hygiene to remove foul-smelling secretions and help prevent anorexia is explained. The patient is taught to dispose of secretions, to cleanse items contaminated by secretions, and to wash hands thoroughly to avoid spreading infection. Air pollutants and people with upper respiratory infections should be avoided. If the patient smokes, he or shemay need a referral to a smoking cessation program or nicotine patches. Prescribed medications (antibiotics, bronchodilators, and expectorants) are given, and both patient and family are instructed in their use, action, and side effects. The patient is advised not to take over-the-counter drugs without the health care provider's approval and to have respiratory infections treated promptly. Supportive care is provided to help the patient adjust to the lifestyle changes that irreversible lung damage requires. Balanced, high-protein meals (in frequent, small amounts if necessary) aid tissue healing. If surgery is scheduled, the patient is prepared physically and emotionally. Preoperative and postoperative teaching and care are conducted, and the patient's status is monitored to prevent complications.