Understanding the Bronchiectasis Prognosis Understanding the Bronchiectasis Prognosis Now! Here!

The article below will discuss the bronchiectasis prognosis of in a complete and detailed. Before you find out about the bronchiectasis prognosis, would be better if you also have to know some things about bronchiectasis such as epidemiology, definition, and fatofisiologi Pathogenesis, pathology, etiology and predisposing factors, clinical features, clinical manifestations, physical examination, diagnosis and treatment of bronchiectasis .

Epidemiology of bronchiectasis
Before you know about bronchiectasis prognosis then the first thing you need to know the epidemiology bronchiectasis. Worldwide incidence of bronchiectasis is still high, usually occurring in underdeveloped countries or developing countries. In the era before antibiotics the symptoms usually appear in the first decade of life. Currently moving towards the onset of adulthood. With limited data, some studies estimate that between 60-80 years of age is the age most affected by the frequency of bronchiectasis disease.

Definition of bronchiectasis
The next thing you should know before bronchiectasis prognosis is the definition of bronchiectasis bronchiectasis. Bronchiectasis was first introduced by Laenec in 1819. Bronchiectasis is a chronic respiratory disease (the bronchi and the tree/bronchioles) with characteristics of a permanent abnormal dilatation accompanied by damage to the bronchial wall. Usually found in the area varied changes including trans mural inflammation, mucosal edema (cylindrical bronchiectasis), ulceration (cystic bronchiectasis) with neovascularization and the incidence of recurrent obstructs due to infection (bronchiectasis varicose) resulting in changes in bronchial wall architecture and function. Circumstances which often induce the occurrence of bronchiectasis are infection, failure drainage secretions, and airway obstruction or interference with the individual s defense mechanisms. Etiology bronchiectasis Exact cause of bronchiectasis is not known, but many factors which may result in bronchiectasis, both hereditary factors and acquired factors and it is important for bronchiectasis prognosis. I. Congenital Factor This rationale first put forward by Grawitz 1880, later followed by Sourbruch. Sourbruch suggests that 8% of cases of bronchiectasis are a congenital abnormality. Wayne and Taussing reported 2 cases of bronchiectasis as a result of congenital abnormalities in both cases the type of bronchiectasis was saccular type appealable. On examination bronkografi. Bronchial collapse seemed at the time of expiration and inspiration at the time of the occurrence of dilatation. This description Underclassman signs of bronchial cartilage deficiency.
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Other bronchiectasis congenital abnormalities are associated with Kartagener syndrome. It is said in the literature only 20% of patients with dextrocardia suffer from bronchiectasis. Olen therefore of opinion on Congenital bronchiectasis is still controversial, whether it occurs congenital bronchiectasis or occur after birth but that symptoms are shown at an early age is very little life and symptoms of bronchiectasis was evident after the patient has an infection such as pertussis, influenza and morbili. Other abnormalities associated with congenital factor are sequestering lung, pulmonary cystic fibrosis, hypogammaglobulinemia and peripheral nerve disorders bronchial wall. Factor of obstruction and infection Obstruction and infection factors play an important role in the occurrence of bronchiectasis. a) Obstruction: Obstruction can occur at most of the small bronchi branch or on one branch of a large bronchus. Bronchial obstruction in the small branches can be caused by aspiration of mucus into the bronchial lumen, which causes the collapse in the distal part of the obstruction. This situation will cause obstruction of the proximal intraluminal pressure will increase, thus resulting in dilatation of the bronchi in case of infection in the bronchial dilatation as well as destruction of the bronchial wall occurs, there will be a permanent dilatation of bronchi This situation usually occurs in children who suffer. Pneumonia and bronchopneumonia who received inadequate treatment. Bronchial obstruction in a large branch in causing collapse of the distal obstruction. If there is infection and destruction of bronchial wall collapse in the bronchi that will happen permanent dilatation of bronchi. Obstruction factors are factors that contribute to the occurrence of persistent infection in a state of obstruction, drainage of secretions in the distal part of the state suffers when this happens continuously will cause bronchial dilatation and destruction. b) Factors of infection: Acute respiratory tract infections such as bronchopneumonia peribronkial can cause tissue destruction. Peribronkial tissue damage will cause the withdrawal of the bronchial wall causing dilatation of the bronchi. Pathogenesis bronchiectasis Iranian classification of bronchiectasis is presented, but is deemed to include broader aspects is the classification of Reid and it is important for bronchiectasis prognosis. Reid in 1950 divided into 3 types of bronchiectasis: 1. Silindris - cylindrical bronchiectasis

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2. Varicose 3. Victim or saccular Silindris type is often associated with pulmonary parenchymal damage there is the addition of bronchial diameter occurs in varicose type bronchiectasis bronchial dilatation is accompanied by a local constriction in the walls of the tipi bronchus cystic dilatation of progressive dilatation of the bronchi walked toward the bubble-shaped peripheral dam. Bronchiectasis often occurs after a lung infection caused by viruses, mycoplasma and tuberculosis all processes related to inflammation and tissue damage to , also on other conditions that cause pulmonary inflammation without his infection, such as ammonia inhalation, gastro esophageal reflux and pulmonary hypnosis can cause bronchiectasis . Failure of lung defense mechanisms causes chronic lung damage. Mukocilier clearance is a mechanism that most efficient in removing respirable particles including bacteria, aided by local immunoglobulin, especially IgA and phagocytes, especially macrophages. Sometimes mechanical me this is not strong enough to carry out their duties eg if inhaled bacteria are quite a lot. At this time experiencing pulmonary inflammatory processes and plasma proteins including immunoglobulin and complement enter into the tissues and secretions. Besides circulating phagocytes (neutrophils monocytes dean gathered to enhance phagocytosis of bacteria. There is also a disorder that causes lung defense mechanisms persistent bacterial infections such as the immotile cilia, granulomatous hipogammaglobulinernia and chronic disease. Semarang is now known that proteolysis enzymes released by phagocytes that gather and direct cause tissue damage that finally happened bronchiectasis. This enzyme is derived from the neutrophil elastase (NE). The role of NE in the pathogenesis of bronchiectasis is evidenced by the occurrence of bronchiectasis in patients with alpha 1 antitrypsin deficiency. This protein is the most powerful natural inhibitor to NE and in the event of deficiency it could lead to the NE that is released from neutrophils remains, active and
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cause tissue damage even though the infection is mild. When found, bronchiectasis is usually accompanied by impaired clearance and will increase the disruption mukocilier other defense mechanisms. Because of that subject would be vulnerable to persistent and recurrent infections and potentially to further lung damage due to accumulation of phagocytes. These two components namely the decrease in clearance and persistent infection will lead to bronchiectasis. Condition associated with bronchiectasis 1. Bronchial obstruction: Bronchiectasis pascaobstruction can occur in patients with end bronchial tumors, bronkolitiasis and inflammatory disorders such as tuberculosis and foreign body aspiration. Can also occur in patients with medial lobe syndrome. 2. Infection: Bronchiectasis can be derived from necrotic lung infections untreated Rosenstein et al. first give attention to bronchiectasis after bronkopulmoner necrosis caused by Klebsiella, Staphylococcal, other aerobic bacteria and a tuberculosis. Can also by M. nontuberkulosis, Mycoplasma pneumonia, anaerobic pulmonary infections and complications of measles, pertussis influenza and adenovirus type 7. Carson et al .. Found impaired acquisition of cilia in the nasal epithelium of children with viral infections in upper respiratory tract. Most of the infected adenovirus Para influenza. With electron microscopy visible loss of epithelial cilia progressively during episodes of infection. 3. Inflammation: In bronchiectasis has been reported the occurrence of combustion of ammonia in the airways and after expires stomach acid that may occur in bronchopulmonary infection that causes infiltrates on chest Xray picture. Although it is known that the infection is the most hoops in bronchiectasis but the effects of acid gastric ulceration also come into play. 4. Allergic bronchopulmonary aspergillosis: Allergic bronchopulmonary aspergillosis is characterized by bronchospasm, bronchiectasis and secretions that contain aspergillums. Pathophysiology involves a hypersensitivity reaction to inhaled antigen in the tracheobronchial branching. Bronchiectasis occurs as a result of blockage of secretions that contain Hipa of aspergillums. The process involves an allergic reaction type I (immediate), type 3 Arthus and there was an increase. Serum levels of IgG and IgE. Scadding believes that the discovery of the proximal saccular bronchiectasis in the upper lobe is typical for allergic bronchopulmonary aspergillosis, but this does not occur in all cases and occurred also in patients with bronchiectasis by other reasons. 5. Immune Deficiency:
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Bronchiectasis and other chronic diseases as well as frequent relapses sinopulmoner infection usually occurs in patients with congenital or acquired immune deficiency. Abnormal B lymphocytes are often associated with bronchiectasis. Hipogammaglobulinemia congenital or acquired is characterized by a decrease. Or loss of circulating IgG in some patients with bronchiectasis. 6. Alpha 1 antitrypsin deficiency: Although this condition is often associated with emphysema, but Laurel and Ericson in 1963 found the alpha I antitrypsin deficiency in two of three patients with bronchiectasis, but pathogen precisely remains unclear. Alpha I antitrypsin to inhibit proteolysis enzymes that can crush lung possibility is that the protease inhibitory lawyer protect the lung during infection or other inflammatory conditions and lung parenchyma and the airways become more susceptible to damage if the substance is lacking. 7. Primary Cilia dyskinesia: Site total inverses, bronchiectasis and nasal polyps or recurrent sinusitis is often found in Kartagener s syndrome. 8. Cystic Fibrosis: Cystic Fibrosis is characterized by impaired chloride transport disorder resulting turnover chloride into the cell. There is accumulation of chloride inside the cells so that cells become dry and secretions become thick and even petrified. These circumstances cause chronic irritation and resulting in recurrent infections. Clinical Manifestation Bronchiectasis

Not all patients with bronchiectasis provide complaints and symptoms. Bronchiectasis is known as dry bronchiectasis. Which is usually located in the upper lobe? The most common complaint is chronic productive cough. Morning cough, especially in patients with a lot of sputum, cough will occur throughout the day. Sputum nature always varies in each case. Sputum sometimes white and sometimes colored yellow in patients with severe infections sputum number could reach 400 500 cc / day. Coughing of blood occurs in 50 70% of cases bronchiectasis. Rupture of bronchial arteries can cause
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a massive coughing up blood. Ulceration of the bronchial wall can cause coughing up blood. Bronchiectasis patients often complain of recurrent fever. Another common complaint was chest pain and shortness of breath. On physical examination abnormalities were found hanging from the area, as well as the degree of airway obstruction that occur. Clubbing is often found in people with bronchiectasis old. Sometimes not found physical abnormalities. Lung disorder that is often encountered is wet crackles. Other disorders that can also be found are clada movement disorders. Abnormalities in cardiac percussion and shifting boundaries. Radiological bronchiectasis In plain radiographic bronchiectasis often give a normal picture. Ogilvie get 6 of 68 case series have normal radiology finding. CXR in bronchiectasis provides an illustration: Bronkovaskuler increases Atelectasis Lung collapse Cystic with or without air fluid level

When the plain chest X-ray picture is not clear tomogram examination can be done. Bronkografi more accurate examination to determine the type and extent of the bronchiectasis. According to Simon, although bronkografi seems harmless, should not be done without a specific purpose, such as bronkografi only to determine the diagnosis is clear and visible on plain photo tomogram. The main indications to perform bronkografi: 1. for the radiological diagnosis - strengthen the diagnosis of bronchiectasis, when clinical suspicion of bronchiectasis whereas normal chest radiograph and tomogram normal or abnormal but no sufficient characteristics to establish the diagnosis of bronchiectasis - In the case of blood cough cases that cannot be explained by the cause - Strengthen information about the nature of lesions that appear at regular chest X-ray picture and the tomogram.
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2. To know the exact anatomic location, size and segmental distribution of the bronchiectasis. This will be done when considering surgery or postural drainage is more appropriate. Bronkografi should be done if the patient is stable, and already done a good bronchial hygiene and it is important for bronchiectasis prognosis. It is important to avoid mistakes in the assessment. A lot of secretions or blood in the lumen of the bronchi may provide an incomplete picture of the state of the bronchial wall. In congestive heart failure and in patients with poor lung function hopefully examination is not done. Other Examination of bronchiectasis Sputum: Sputum patients with infections, often times if left in place will form a third layer of the upper layer of clear serous middle layer and lower layer consisting of turbid pus and cellular debris. Microscopically would seem fibers elastic fibers and fibers of muscle fibers as a result of the destruction of the bronchial wall due to inflammation. For bacteriological examination materials should be taken with aspirations transracial sputum. Performed the outward appearance inspection grams, culture and resistance testing. EXAMINATION OF BLOOD Blood tests are sometimes within normal limits. Anemia is caused by the Harmonic course of the disease. Leukocytosis occurs when there is active infection with suppuration. Diagnosis of bronchiectasis Diagnosis is often already be established from the history of recurrent cough, recurring fever, coughing up blood that accompanied the picture with or without cystic air fluid level on regular chest X-ray. Bronkografi examination to determine a definitive diagnosis. MANAGEMENT bronchiectasis Management of patients with bronchiectasis is very important for bronchiectasis prognosis, basically consists of four things: 1. Provision of medicines 2. Physiotherapy 3. Surgery

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4. Prevention efforts. Provision of medicines 1. Antibiotic Antibiotics are meant to control the infection that occurs and it is important for bronchiectasis prognosis. In patients with ambulatory patients who are given antibiotics in case of changes in the nature of the mucous sputum becomes purulent sputum and increasing the amount of: Antibiotics must be in accordance with the results of resistance testing. In a state of acute exacerbation of a broad-spectrum antibiotics are given Robert and Ingold in their research have That amoxicillin 2 g / day gives better results compared with ampicillin 4 g / day. This is because the absorption of amoxicillin into the bronchial secretions better than ampicillin. 2. Bronchodilators Bronchodilator drugs may be given medication in patients with bronchiectasis who gives a picture of chronic bronchitis and airway obstruction and it is important for bronchiectasis prognosis. Bronchodilators are useful to improve the clearance mukocilier, smooth muscle relaxation and reduce edema mucosa. Benefits of bronchodilators in patients with bronchiectasis by using salbutamol been examined by Nojrodi et al .. There VEP1 increase of 16% after administration of inhaled salbutamol. 3. Mucolytic and expectorant Mucolytic drug is a drug that can thin the secretions in the airways by reducing or eliminating the threads and mukoprotein mucopolysaccharide sputum and it is important for bronchiectasis prognosis. The use of medicinal drugs in patients with bronchiectasis mucolytic particularly useful to say on the state of a substance that increases the toxicity of substances like peroxide on acrolein toxicity. Expectorant drug is a drug that can stimulate the secretion of phlegm from the airways. Mechanism of action is to stimulate expectorant gastric mucosa and subsequent reflexively stimulate the secretion of the airways, thereby reducing sputum viscosity and facilitate expenditure. Has become customary to use a cough expectorant every complaint. Until now no data showing an increase in the clearance or repair of a constant condition of the patient after administration of expectorant. According to Cott GR, very few of the benefits of expectorant. 4. Steroids

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Steroids should be considered if found any component of allergic aspergillums bronkopulmoner commoners and also proved effective in bronchiectasis caused by cystic fibrosis and sometimes and it is important for bronchiectasis prognosis. 5. Other therapies Gamma globulin effective in patients with hipogammaglobulinemia and should be given a lifetime and it is important for bronchiectasis prognosis. The benefits of this therapy in secondary hipogammaglobulinemia state remain unclear, but may be useful in a failed state with antibiotic therapy. Immune suppression therapy is useful in circumstances of severe infections caused by increased immunoglobulin and immune complex. Antacids can be given to people associated with gastrointestinal reflux. Radiotherapy is useful at least in the short term, if the occlusion of tumor is the cause of disease. Treatment of any infection, upper respiratory symptoms sometimes can improve bronchiectasis. Physiotherapy Physiotherapy in patients with bronchiectasis meant to remove secretions in the airways and it is important for bronchiectasis prognosis. With adequate physiotherapy secretions in the airways will flow out and this can significantly improve lung function.

Physiotherapy is done is breathing exercises and postural drainage. Postural drainage is performed if excessive sputum production and sputum retention occurred. Postural drainage is not recommended in patients with impaired pulmonary physiology or patients with severe heart trouble. Postural drainage positions depending on the location of the affected segment. SURGICAL Surgery is performed when conservative treatment is adequate with no complaints remained basically the surgery performed on - Recurrent infections - recurrent coughing up blood - massive coughing up blood

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The operation performed depends on the location, size and lung function can be segmentektomi Surgery patients, lobectomy or pneumonectomy and it is important for bronchiectasis prognosis. Surgery does not guarantee the patient free from bronchiectasis. Ginsberg et al. found 85 of 221 cases operated on their side of the bronchiectasis. Prevention of bronchiectasis Prevention efforts include the provision of immunization, adequate treatment in patients with pneumonia, bronchopneumonia, pertussis and morbili and it is important for bronchiectasis prognosis. for patients with bronchiectasis made the effort to prevent people from avoiding ingredients that can stimulate the production of excessive secretions. Avoiding irritants away from the material, sleeping pills and drugs that suppress cough. Complication bronchiectasis 1. Pneumonia Often develop recurrent exacerbations of upper respiratory tract infections. These infections often involve abnormal bronchial area. 2. Pleuritis Pleural pain may arise in conjunction with pneumonia usually develops from the upper respiratory tract infection. 3. Pleural effusion or empyema Pleural effusion or empyema is relatively rare in bronchiectasis. 4. Sinusitis Sinusitis is a common complication of bronchiectasis and almost certainly occurs in severe cases. 5. Hemoptysis Hemoptysis sometimes occurs in bronchiectasis, and most often is mild hemoptysis. In recurrent hemoptysis and uncontrolled, is an indication for resection. Location of the source of bleeding is sometimes difficult to determine. 6. Brain abscess

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A brain abscess is a complication of chronic bronchiectasis. Once this is the worst cause of death. When these complications are extremely rare. 7. Amyloidosis Although amyloidosis is a very rare complication, but this possibility should still be considered. In the event of an enlarged liver or spleen, the possibility of amyloidosis should be considered. Bronchiectasis Prognosis At the time of modern medicine has not been introduced, the bronchiectasis prognosis is poor, with bronchiectasis modern treatment, medical or surgical prognosis (life expectancy) was good but this disease cannot be cured completely. Conclusion bronchiectasis 1. Clinical manifestations of signs and symptoms depending on severity of bronchiectasis include chronic cough, recurrent disease, with recurrent, repetitive coughing up blood and coughing up blood sometimes massive On examination found shortness of breath, clubbing and crackles wet. 2. The diagnosis of bronchiectasis often can be established from a history of recurrent productive chronic cough, recurring fever, coughing up blood repeatedly with cystic image with or without water fluid levels on plain chest X-ray or tomogram. To determine a definitive diagnosis bronkografi examination. 3. Antibiotics are given when there is an increased amount of sputum, and no change in the nature of the mucous sputum becomes purulent. antibiotics should be adjusted with the results of resistance testing. 4. granting mucolytic beneficial in patients with bronchiectasis. Expectorant unclear benefits. 5. Physiotherapy greatly helps remove secretions from the airways. 6. Surgery is only done if there is recurrent infection, recurrent coughing up blood and coughing up blood massive. Hopefully this article on bronchiectasis prognosis of benefit to you.

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