Bronchiectasis - Respiratory Care Pathophysiology (Ch.16)

Vocabulary flashcards covering Bronchiectasis concepts, forms, causes, diagnosis, imaging, and management from the lecture notes.

Bronchiectasis

Chronic dilation and distortion of bronchi from extensive inflammation and destruction of bronchial wall components; mucociliary clearance is impaired.

Cylindrical bronchiectasis (Tubular)

A form with uniform, cylindrical dilation of the bronchi.

Varicose bronchiectasis (Fusiform)

Irregular, beaded dilation of bronchi with alternating constrictions.

Cystic bronchiectasis (Saccular)

Most severe form with sac-like, ballooned dilations of bronchi.

Mucociliary clearance

Airway mechanism for clearing mucus and debris; impairment contributes to bronchiectasis.

Etiology categories

Bronchiectasis results from a combination of bronchial obstruction and infection; major categories include acquired obstruction, congenital defects, immunodeficiency, abnormal secretion clearance, and miscellaneous disorders.

Cystic Fibrosis (CF)

Autosomal recessive disease; thick secretions and defective ion transport lead to bronchial damage; CF accounts for about 50% of bronchiectasis in the US.

Kartagener’s syndrome

Triad of bronchiectasis, dextrocardia, and chronic rhinosinusitis due to defective cilia.

Dextrocardia

Heart located on the right side; part of Kartagener’s syndrome.

Defective cilia

Impaired ciliary function causing reduced mucociliary clearance and susceptibility to bronchiectasis.

Immunodeficiency states

Conditions that weaken immune defense and can contribute to bronchiectasis.

Incidence of non-CF bronchiectasis

Approximately 4.2 cases per 100,000 young adults in the United States.

Mucociliary clearance impairment

Failure of airway clearance of mucus, promoting infection and bronchial damage.

Anatomic alterations

Chronic dilation/distortion of airways, excessive foul-smelling sputum, bronchospasm, air trapping with hyperinflation, atelectasis, and possible parenchymal fibrosis.

Hemorrhage in bronchiectasis

Bleeding from eroded bronchial arteries as a potential complication.

Cough with foul-smelling sputum

A common symptom reflecting chronic infection and mucus accumulation.

Hemoptysis

Coughing up blood, common in bronchiectasis with heavy sputum.

Digital clubbing

Bulbous enlargement of distal digits associated with chronic hypoxemia.

Cyanosis

Bluish discoloration due to low oxygen levels.

Chest exam: obstructive pattern

Decreased tactile fremitus, hyperresonant percussion, diminished breath sounds, and may include wheezing.

Chest exam: restrictive pattern

In areas of atelectasis/consolidation: increased fremitus, bronchial breath sounds, crackles, dull percussion.

Pulmonary function tests (PFTs): obstructive pattern

Decreased FEV1, decreased FEV1/FVC ratio, reduced mid-range flow (e.g., FEF25–75), and reduced MVV.

Pulmonary function tests (PFTs): restrictive pattern

Reduced lung volumes (TLC, VC, FRC) with relatively preserved or increased FEV1/FVC ratio.

Arterial blood gases (ABG): acute pattern

Acute alveolar hyperventilation with hypoxemia; respiratory alkalosis.

Arterial blood gases (ABG): chronic pattern

Chronic ventilatory failure with hypoxemia; compensatory respiratory acidosis (elevated PaCO2 with increased HCO3−).

Signet ring sign

Imaging sign where dilated bronchi appear as a ring next to a small vessel, commonly seen in bronchiectasis (notably CF).

Tram-tracking

Radiologic sign of parallel lines from thickened bronchial walls on chest radiographs.

Radiologic features: obstructive vs. restrictive

Obstructive: translucent lungs, hyperinflation, depressed diaphragms; Restrictive: atelectasis/consolidation with increased opacity.

Management goals

Control pulmonary infections, control airway secretions, and prevent complications.

Respiratory care protocols

Oxygen therapy; bronchopulmonary hygiene (airway clearance); lung expansion exercises; aerosolized medications; mechanical ventilation; antibiotics and expectorants as needed.