The classic clinical manifestations of bronchiectasis are cough and daily mucopurulent sputum production, often lasting months

to years. Blood-streaked sputum or hemoptysis may result from airway damage associated with acute infection. Less specific symptoms include dyspnea, pleuritic chest pain, wheezing, fever, weakness, and weight loss.

Weight changes(weight loss) Finger Clubbing( Cystic Bronchoectasis) Nasal mucosa(rhinitis,pus =PCD) Sputum(Hemoptysis) Spirometry Ambulatory desaturation Echocardiography(PHTN,right heart Dysfunction)

When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lobes of the lungs. Tests may include: Aspergillosis precipitin test (to check for signs of the aspergillosis fungus) Alpha-1 antitrypsin blood test Chest x-ray Chest CT Sputum culture Complete blood count (CBC) Genetic testing, including sweat test for cystic fibrosis PPD skin test to check for a prior tuberculosis infection Serum immunoglobulin electrophoresis

POSTURAL DRAINAGE: Drainage by gravity of secretions from various lung segments CHESTPHYSIOTHERAPY: Forceful striking of the skin with cuff hands Purpose: promote bronchial drainage to clear excessive secretions from the affected portion of the lungs to prevent or control of infection

SMOKING CESSATION: smoking impairs bronchial drainage by paralyzing ciliary action, increase bronchial secretions and causing inflammation of the mucous membrane, resulting in hyperplasia of mucous glands

ANTIMICROBIAL THERAPY: used to help fight respiratory infections physicians prescribe antibiotics throughout winter or when acute respiratory tract occurs

Bronchodilator Medications Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve symptoms of bronchiectasis by relaxing and opening the air passages in the lungs.

Steroids Inhaled as an aerosol spray, steroids can help relieve symptoms of bronchiectasis. Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood pressure, diabetes and cataracts. It is important to discuss these side effects with your doctor before using steroids.

Mucus Thinners and Expectorants Mucus thinners and expectorants help loosen and clear mucus from lungs.

SEGMENTAL RESECTION:
a.k.a. Segmentectomy Removal of a segment of a lobe

LOBECTOMY removal of lobe of a lung

PNEUMONECTOMY removal of the entire lung Removal of the right is more dangerous than the left because right has a larger vascular bed and its removal imposes a greater physiologic burden

Is the same as for COPD

Provide supportive care and help the patient adjust to the lifestyle changes that irreversible lung damage necessitates Administer antibiotics, as ordered, and record patients response to this medication. Give oxygen as needed.

Management for Bronchiectasis

Perform chest physiotherapy, including postural drainage and chest percussion for involved lobes, several times per day, especially early morning and before bed time. Provide warm, quiet, comfortable environment. Also help the patient to alternate rest and activity periods.

Give the patient well balanced, high caloric meals. Offer small, frequent meals or nutritional supplements. Make sure the patient receives adequate hydration to help thin secretions and promote easier removal.

Give frequent mouth care to remove foul-smelling sputum. Provide the patient with tissues and waxed bag in which to dispose contaminated tissues. Monitor the patients respiratory rate and pattern regularly

Asses gas exchange by monitoring ABG values as orered. Observe the patients breath sounds and sputum production for changes that might indicate a respiratory infection or worsening condition.

It may be treated by: Surgical Resection if the pathologic process is well localized in one lobe or two adjacent lobes and when no contraindications to surgery exists.