BRONCHIECTASIS

• Bronchiectasis (broncos – airways, ectasia – dilation ) is an irreversible and abnormal dilation in the bronchial tree that is generally caused by cycles of bronchial inflammation in addition to mucous plugging and progressive airway destruction
• The most important clinical finding is a chronic cough with copious mucopurulent sputum. Other symptoms may include dyspnoea, rhinosinusitis, and haemoptysis
• It affects all ages, although the prevalence increase with age. Bronchiectasis should be suspected in patients with a chronic cough that produces large amounts of sputum

Pulmonary infections (i.e. bacterial, viral, fungal)

Bronchial narrowing or other forms of obstruction

• COPD
• Aspiration
• Tumours
• α1-antitrypsin deficiency
• congenital bronchiectasis, tracheomalacia, bronchogenic cyst

Disorders of secretion clearance or mucous plugging

• Cystic fibrosis (CF) 
• Primary ciliary dyskinesia
• Allergic bronchopulmonary aspergillosis
• Kartagener syndrome
• Smoking: associated with poor ciliary motility

Immunodeficiency

• Chronic inflammatory diseases
• Rheumatoid arthritis
• Sjogren’s syndrome
• Crohn’s disease

• Productive cough, the most common complaint, is almost invariably present and leads to chronic bronchitis
• Cough is long standing, copious, purulent with sputum that is worse in the morning
• Bronchiectasis sicca (dry) with no sputum production and episodic haemoptysis may occur due to localised upper lobe bronchiectasis and autogenic drainage
• Increased cough, sputum volume and purulence, wheeze, fever, haemoptysis and chest pain define the presence of acute exacerbation
• Rhinosinusitis
• Dyspnoea
• Haemoptysis – is usually mild or self-limiting, but severe haemorrhage that requires embolization may occur 
• Nonspecific symptoms ( fatigue, weight loss, pallor due to anaemia)
• Clubbing of nails (uncommon)

On Auscultation

• Crackles and rhonchi
• Wheezing
• Bronchophony

Chest X-Ray

• Best initial test , shows tram track lines ( characteristic sign of bronchial wall thickening)
• Thin-walled cysts (i.e. dilated bronchi forming sacs), possibly with air-fluid levels
• Honeycombing in late-stage bronchiectasis

High-resolution computer tomography (HRCT)

• Is the confirmatory test
• Dilated bronchi with thickened walls; possible signet-ring appearance and tram track lines
• Cysts, especially at bronchial ends in lower lobes, and honeycombing

Other tests

• Sputum culture and smear: to determine infectious etiology (bacteria, mycobacteria, and fungi)
• CBC with differential: ↑ WBCs, ↑ neutrophils
• Pulmonary function tests: findings consistent with obstructive pulmonary disease
• Bronchoscopy

• Bronchiectasis is a permanent anatomical malformation and therefore cannot be cured.
• Address the underlying symptom
• Goal of Treatment is to reduce disease progression, maintain and improve lung function, reduce infective exacerbations and improve the quality of life
• Airway clearing techniques – Breathing techniques
• Hydration – Adequate intake of oral fluid
• Surgical resection of bronchiectatic lung or lobectomy
• Lung transplantation should be considered in severe disease

Internal Medicines

• Dashamoola katutraya kashaya
• Nayopayam kashaya
• Vyagradhi kashaya
• Svasananda rasa
• Dhanwantara gutika
• Kasthuryadi gutika
• Dashamoolarishta
• Kanakasava + Vasarishta
• Dashamoola rasayana
• Kooshmanda rasayana
• Indukanta Ghrita

Procedures 

• Pranayama
• Karpooradi taila - ext application on chest
• Busa pinda sweda