Points to Ponder for NEET-PG, FMGE & NEXT
- Bronchiectasis is caused by damage and widening of the airways, leading to chronic mucus production and persistent infections.
- Chronic cough with purulent sputum, hemoptysis, and dyspnea are typical symptoms.
- HRCT chest is the gold standard for diagnosis, while chest X-ray and PFTs may be used adjunctively.
- Early diagnosis and management are crucial to prevent complications like cor pulmonale.
Definition:
- Bronchiectasis is a chronic lung condition where the airways (bronchi) become permanently damaged, widened, and scarred.
- This abnormal structure makes it difficult to clear mucus, leading to recurrent infections and breathing problemsà Left lower Lobe the Mc affected lobe.
Causes:
- Obstruction:
- Tumors pressing on the airways.
- Foreign objects inhaled into the lungs.
- Infections: Repeated or severe lung infections can damage the airways over time.
- Genetic disorders:
- Cystic fibrosis (CF): Thick mucus plugs airways.
- Kartagener’s syndrome: Affects cilia (hair-like structures) that help clear mucus, leading to recurrent infections.
- Aspiration: Regularly inhaling foreign material like food or fluids.
- Allergic bronchopulmonary aspergillosis (ABPA): A hypersensitivity reaction to the fungus Aspergillus fumigatus, which can damage airways.
Symptoms:
- Recurrent infections: Bronchitis or pneumonia, especially before widespread antibiotic use.
- Chronic cough: Produces excessive amounts of sputum (phlegm), which may be foul-smelling due to infection.
- Hemoptysis: Coughing up blood due to damaged blood vessels in the airways.
- Shortness of breath (dyspnea): Can worsen over time as lung function declines.
- Right heart failure (cor pulmonale): In severe cases, the heart struggles to pump blood due to high pressure in the pulmonary arteries caused by lung disease. This can lead to fatigue, swelling in the legs, and right-sided heart enlargement.
Investigation of Choice:
- High-resolution computed tomography (HRCT) chest: The most sensitive and specific imaging test for diagnosing bronchiectasis. It provides detailed images of the airways to identify characteristic features of bronchiectasis.
Other investigations may include:
- Chest X-ray (less sensitive than HRCT but readily available).
- Sputum culture to identify any causative bacteria.
- Pulmonary function tests (PFTs) to assess lung function.
