Bronchiectasis

University College of Nursing
Bronchiectasis
Definition- Bronchiectasis is a chronic respiratory condition characterized by
abnormal widening and distortion of the bronchial tubes (airways) in the lungs.
Risk factors include:
1. Severe or recurrent respiratory infections, especially during childhood.
2. Cystic Fibrosis: This genetic condition affects the mucus-producing

glands, leading to thick, sticky mucus that can clog the airways and
predispose individuals to bronchiectasis.
3. Immune System Disorders: HIV/AIDS or autoimmune diseases like

rheumatoid arthritis
4. Allergic Bronchopulmonary Aspergillosis (ABPA): This is a condition

where individuals have allergic reactions to the fungus Aspergillus in the
lungs, which can lead to inflammation and damage to the airways.
5. Inhalation of Foreign Objects
6. Severe Gastroesophageal Reflux Disease (GERD)
7. Smoking
8. Environmental Factors: Exposure to pollutants, occupational dust, or

toxic fumes.
9. Genetic predispositions
10.Other Lung Conditions: tuberculosis, pneumonia, or severe asthma,
Pathophysiology
1. Airway Injury and Inflammation: initial insult or injury to the airway can
result from various. The initial insult triggers an inflammatory response
in the airway walls.
2. Impaired Mucus Clearance: In response to the inflammation, the airway

walls become thickened and damaged. The normal mechanisms for
clearing mucus from the airways, including cilia and mucociliary
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clearance, become impaired. As a result, mucus production increases,

but the ability to remove it from the airways is compromised.
3. Mucus Accumulation: Without effective clearance mechanisms, mucus

accumulates in the bronchial tubes..
4. Chronic Infections: Persistent mucus accumulation and bacterial

colonization lead to recurrent respiratory infections. These infections
further perpetuate inflammation and airway damage, creating a vicious
cycle.
5. Bronchial Dilation: Over time, the inflammation and damage to the

airway walls cause them to lose their elasticity and structural integrity.
As a result, the bronchial tubes become dilated and distorted, leading to
the characteristic bronchiectasis.
6. Impaired Gas Exchange: As bronchiectasis progresses, the structural

changes in the airways can impair gas exchange in the lungs. The dilated
and damaged bronchial tubes may trap air, reducing the efficiency of
oxygen exchange between the air and the bloodstream.
Clinical symptoms and signs,
1. Chronic Cough: A persistent cough is one of the hallmark symptoms of

bronchiectasis. The cough may produce large amounts of sputum
(mucus) that can be clear, white, yellow, green, or occasionally blood-
tinged.
2. Sputum Production: Patients with bronchiectasis often produce copious

amounts of thick, tenacious sputum. The sputum may have a foul odor
and may vary in color depending on the presence of infection.
3. Dyspnea (Shortness of Breath): Difficulty breathing, particularly with

exertion, is common in bronchiectasis. This symptom can be due to
impaired gas exchange as well as airway obstruction caused by mucus
accumulation.
4. Wheezing: Wheezing, a high-pitched whistling sound during breathing,

can occur due to airway narrowing and obstruction caused by
inflammation and mucus accumulation.
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5. Chest Pain: Some individuals with bronchiectasis may experience chest

pain, which can vary in intensity and may worsen with coughing or deep
breathing. This pain can be due to inflammation of the airways or
associated conditions such as pleurisy.
6. Hemoptysis: Coughing up blood or blood-tinged sputum (hemoptysis)

can occur in bronchiectasis, particularly during exacerbations or in
advanced cases where there is significant airway damage.
7. Recurrent Respiratory Infections: Bronchiectasis predisposes individuals

to frequent respiratory infections, including bacterial, viral, and fungal
infections. These infections can lead to exacerbations of symptoms and
may require antibiotic treatment.
8. Fatigue and Malaise: Chronic respiratory symptoms and recurrent

infections can lead to fatigue, weakness, and a general feeling of illness
(malaise).
9. Weight Loss: Some individuals with bronchiectasis may experience

unintentional weight loss, particularly if they have poor appetite due to
chronic respiratory symptoms or frequent infections.
10.Clubbing of Fingers: In advanced cases of bronchiectasis, clubbing of the

fingers and toes (enlargement and rounding of the fingertips) may
develop due to chronic hypoxia (low oxygen levels) and poor perfusion.
Diagnostic evaluation
1. Medical History and Physical Examination:
 A thorough medical history is obtained to assess for risk factors,

symptoms, and potential triggers of bronchiectasis.
 A comprehensive physical examination is performed to assess

respiratory symptoms, signs of chronic lung disease, and any
associated findings such as clubbing of the fingers.
2. Imaging Studies:
 Chest X-ray
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 High-Resolution Computed Tomography (HRCT) Scan.
3. Pulmonary Function Tests (PFTs):
 Spirometry: Spirometry measures lung function parameters such

as forced vital capacity (FVC) and forced expiratory volume in one
second (FEV1).
 Diffusion Capacity (DLCO): DLCO measures the ability of the lungs

to transfer oxygen from the air sacs into the bloodstream.
Reduced DLCO may indicate impaired gas exchange in
bronchiectasis.
4. Sputum Culture and Sensitivity:
5. Laboratory Tests:
 Complete Blood Count (CBC): leukocytosis
 Immunoglobulin Levels: Measurement of immunoglobulin levels

(IgG, IgA, IgM) may be indicated to evaluate for underlying
immunodeficiency disorders associated with bronchiectasis.
6. Bronchoscopy:
7. Genetic Testing:
cystic fibrosis or primary ciliary dyskinesia.
Medical management
1. Airway Clearance Techniques:
 Airway clearance techniques, such as chest physiotherapy,

postural drainage, and percussion, are used to help loosen and
mobilize mucus from the airways, making it easier to expectorate.
These techniques can be taught by respiratory therapists and
incorporated into the patient's daily routine.
2. Mucolytic Medications:
 Mucolytic medications, such as hypertonic saline or dornase alfa

(DNase), via inhalation.
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3. Bronchodilators:
 Bronchodilator medications, such as short-acting beta-agonists

(SABAs) or long-acting beta-agonists (LABAs), may be used to
relieve bronchospasm and improve airflow in the lungs
4. Antibiotic Therapy:
5. Immunizations:
 Annual influenza vaccination and pneumococcal vaccination
6. Treatment of Underlying Conditions:
7. Smoking Cessation:
8. Pulmonary Rehabilitation:
 Pulmonary rehabilitation programs may benefit patients with

bronchiectasis by improving exercise tolerance, promoting
physical activity, and providing education on self-management
strategies.
9. Nutritional Support:
10.Oxygen Therapy:
11.Regular Follow-Up and Monitoring:
 Patients with bronchiectasis should receive regular follow-up care to

monitor disease progression, assess treatment efficacy, and address any
changes in symptoms or lung function.
12.Surgical Intervention:
 In severe cases of localized bronchiectasis or bronchiectasis associated

with significant hemoptysis, surgical resection of affected lung segments
Nursing Management-
1. Ineffective Airway Clearance related to excessive mucus production

and impaired cough mechanism.
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 Evidence: Presence of chronic cough, copious sputum production,

audible wheezing, and diminished breath sounds on auscultation.
 Interventions: Teach and encourage effective airway clearance

techniques, such as chest physiotherapy, postural drainage, and
proper hydration. Monitor respiratory status and assist with
mobilization of secretions as needed.
2. Impaired Gas Exchange related to ventilation-perfusion (V/Q)

mismatch and impaired alveolar-capillary diffusion.
 Evidence: Dyspnea, decreased oxygen saturation levels, and

abnormal arterial blood gas (ABG) values.
 Interventions: Monitor oxygen saturation levels and ABGs.

Administer supplemental oxygen therapy as prescribed.
Encourage deep breathing exercises and positioning techniques to
optimize lung ventilation and gas exchange.
3. Risk for Infection related to impaired mucociliary clearance and

recurrent respiratory infections.
 Evidence: History of frequent respiratory infections, increased

sputum production, and presence of purulent or blood-tinged
sputum.
 Interventions: Educate the patient about infection prevention

strategies, including hand hygiene, avoidance of sick contacts, and
adherence to recommended vaccinations. Monitor for signs and
symptoms of respiratory infection and initiate prompt treatment
as needed.
4. Activity Intolerance related to dyspnea, fatigue, and reduced exercise

tolerance.
 Evidence: Reports of fatigue, limited mobility, and decreased

ability to perform activities of daily living (ADLs) without
experiencing dyspnea.
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 Interventions: Assess the patient's functional status and tolerance

for physical activity. Encourage energy conservation techniques
and pacing strategies. Collaborate with physical therapists to
develop individualized exercise programs.
5. Anxiety related to chronic respiratory symptoms and fear of

exacerbations.
 Evidence: Reports of anxiety, restlessness, and feelings of

uncertainty about managing the disease.
 Interventions: Provide emotional support and reassurance. Teach

relaxation techniques, such as deep breathing exercises and
guided imagery. Encourage open communication and address
concerns about disease management and prognosis.
6. Deficient Knowledge related to lack of information about

bronchiectasis and self-management strategies.
 Evidence: Patient or caregiver expresses uncertainty or

misunderstanding about the disease process, treatment options,
and preventive measures.
 Interventions: Provide comprehensive education about

bronchiectasis, including its causes, symptoms, treatment
modalities, and strategies for self-care. Use teach-back techniques
to assess understanding and reinforce key concepts
 Explain the purpose, dosage, administration, and potential side

effects of prescribed medications, including bronchodilators,
mucolytics, antibiotics, and oxygen therapy.
 Emphasize the importance of medication adherence and regular

follow-up with healthcare providers.
Complications
1. Recurrent Respiratory Infections:
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2. Chronic Bronchitis:
3. Hemoptysis:
4. Respiratory Failure:
5. Pulmonary Hypertension:
6. Lung Abscess:
7. Empyema:
8. Malnutrition and Weight Loss:
9. Bronchiectasis Exacerbations:
10.Quality of Life Impairment
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University College of Nursing

Risk factors include:

1. Severe or recurrent respiratory infections, especially during childhood.

2. Cystic Fibrosis: This genetic condition affects the mucus-producing

3. Immune System Disorders: HIV/AIDS or autoimmune diseases like

4. Allergic Bronchopulmonary Aspergillosis (ABPA): This is a condition

5. Inhalation of Foreign Objects

6. Severe Gastroesophageal Reflux Disease (GERD)

8. Environmental Factors: Exposure to pollutants, occupational dust, or

10.Other Lung Conditions: tuberculosis, pneumonia, or severe asthma,

2. Impaired Mucus Clearance: In response to the inflammation, the airway

clearance, become impaired. As a result, mucus production increases,

3. Mucus Accumulation: Without effective clearance mechanisms, mucus

4. Chronic Infections: Persistent mucus accumulation and bacterial

5. Bronchial Dilation: Over time, the inflammation and damage to the

6. Impaired Gas Exchange: As bronchiectasis progresses, the structural

Clinical symptoms and signs,

1. Chronic Cough: A persistent cough is one of the hallmark symptoms of

2. Sputum Production: Patients with bronchiectasis often produce copious

3. Dyspnea (Shortness of Breath): Difficulty breathing, particularly with

4. Wheezing: Wheezing, a high-pitched whistling sound during breathing,

5. Chest Pain: Some individuals with bronchiectasis may experience chest

6. Hemoptysis: Coughing up blood or blood-tinged sputum (hemoptysis)

7. Recurrent Respiratory Infections: Bronchiectasis predisposes individuals

8. Fatigue and Malaise: Chronic respiratory symptoms and recurrent

9. Weight Loss: Some individuals with bronchiectasis may experience

10.Clubbing of Fingers: In advanced cases of bronchiectasis, clubbing of the

1. Medical History and Physical Examination:

 A thorough medical history is obtained to assess for risk factors,

 A comprehensive physical examination is performed to assess

 High-Resolution Computed Tomography (HRCT) Scan.

3. Pulmonary Function Tests (PFTs):

 Spirometry: Spirometry measures lung function parameters such

 Diffusion Capacity (DLCO): DLCO measures the ability of the lungs

4. Sputum Culture and Sensitivity:

 Complete Blood Count (CBC): leukocytosis

 Immunoglobulin Levels: Measurement of immunoglobulin levels

cystic fibrosis or primary ciliary dyskinesia.

1. Airway Clearance Techniques:

 Airway clearance techniques, such as chest physiotherapy,

 Mucolytic medications, such as hypertonic saline or dornase alfa

 Bronchodilator medications, such as short-acting beta-agonists

 Annual influenza vaccination and pneumococcal vaccination

6. Treatment of Underlying Conditions:

 Pulmonary rehabilitation programs may benefit patients with

11.Regular Follow-Up and Monitoring:

 Patients with bronchiectasis should receive regular follow-up care to

 In severe cases of localized bronchiectasis or bronchiectasis associated

1. Ineffective Airway Clearance related to excessive mucus production

 Evidence: Presence of chronic cough, copious sputum production,

 Interventions: Teach and encourage effective airway clearance

2. Impaired Gas Exchange related to ventilation-perfusion (V/Q)

 Evidence: Dyspnea, decreased oxygen saturation levels, and

 Interventions: Monitor oxygen saturation levels and ABGs.

3. Risk for Infection related to impaired mucociliary clearance and

 Evidence: History of frequent respiratory infections, increased

 Interventions: Educate the patient about infection prevention

4. Activity Intolerance related to dyspnea, fatigue, and reduced exercise

 Evidence: Reports of fatigue, limited mobility, and decreased