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PHYSIOTHERAPY IN THE

MANAGEMENT OF BRONCHIETASIS

By

ADEYINKA A. O.

ICU

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BRONCHIECTASIS

INTRODUCTION

Bronchiectasis is derived from the to Gree! ords "broncos" me#$i$% airway #$d "ektasis" me#$

stretching&Daljinder, 2010)' Bro$(hie(t#sis des(ri)es # (*i$i(#* (o$ditio$ i$ hi(h there is d#m#%ethe #**s of *#r%er )ro$(hi#* t+)es, ith *oss of the smooth m+s(*e #$d *oss of e*#sti(ity of se%me$ts

the )ro$(hi' The res+*t#$t #ir#y distortio$, therefore, -reve$ts #de.+#te (*e#r#$(e of se(retio$s, fr

the *+$%' This -oo*i$% i$ the distorted #ir#ys -rovides # )reedi$% %ro+$d for )#(teri#* %roth hi

(#+ses i$f*#mm#tio$ #$d m#y *e#d to d#m#%e (#**ed /)ro$(hie(t#sis/' A 0vicious cycle1 is i$iti#

hi(h i$(re#ses the d#m#%e *e#di$% to i$(re#sed i$fe(tio$, #$d the$ to f+rther d#m#%e'

Fi%+re 23 I A (ross4se(tio$ of the *+$%s ith $orm#* #ir#ys #$d ide$ed #ir#ys' II A (ross4se(tio$ of #

$orm#* #ir#y' III A (ross4se(tio$ of #$ #ir#y ith )ro$(hie(t#sis

Fi%' 53 A di#%r#m de-i(ti$% the vi(io+s (y(*e i$ )ro$(hie(t#sis'

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Bro$(hie(t#sis is # form of Chro$i( O)str+(tive P+*mo$#ry Dise#se &COPD6' It (#$ -rese$t #*o$e, )

+s+#**y more th#$ o$e of the COPDs (oe7ist i$ the s#me -erso$' It is +s+#**y *o(#*i8ed i$ # fe se%me$ts

i$ #$ e$tire *o)e of the *+$%' It te$ds to #ffe(t the *eft *+$% more &Porter, 599:6'

ETIO;OGY

26 Post infection &res+*ts di*#tio$ of )ro$(hi#* #**s6

#6 T+)er(o*osis

)6 Me#s*es

(6 Pert+sis &hoo-i$% (o+%h6

d6 P$e+mo$i#

e6 A**er%i( )ro$(ho-+*mo$#ry #s-er%i**osis

2) Obstruction

#6 T+mo+r

)6 Forei%$ )odies

(6 I$fe(tio$ ith )#(!%ro+$d o)str+(tio$ m#y (o$tri)+te to #ir#y destr+(tio$

de7tro(#rdi#?6

TYPES

Bro$(hie(t#sis m#y )e %ro+-ed i$to ty-es3

2' B#sed o$ the #$#tomi(#* #--e#r#$(e of the *+$%s &there #re three -rim#ry ty-es of Bro$(hie(t#sis6

5' B#sed o$ the (#+se'

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A' Cylindrical bronchiectasisis the mi*dest form #$d ref*e(ts the *oss of the $orm#* t#-eri$% of t

#ir#ys' The sym-toms m#y )e .+ite mi*d, *i!e # (hro$i( (o+%h, #$d +s+#**y #re dis(overed o$

s(#$s of the (hest' Cy*i$dri(#* )ro$(hie(t#sis i$vo*ves diff+se m+(os#* edem#, ith res+*t#$t )ro$

th#t #re di*#ted )+t h#ve str#i%ht, re%+*#r o+t*i$es th#t e$d s.+#re*y #$d #)r+-t*y'

Fi%'

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C' Cystic or Saccular bronchiectasisis the most severe form of )ro$(hie(t#sis, #$d fort+$#te*y it is

*e#st (ommo$ form' This ofte$ o((+rred i$ the -re4#$ti)ioti( er# he$ #$ i$fe(tio$ o+*d r+$

(o+rse #$d the -#tie$t o+*d s+rvive ith resid+#* *+$% d#m#%e' These -#tie$ts ofte$ o+*d h#v

(hro$i( -rod+(tive (o+%h, )ri$%i$% +- # (+- or more of dis(o*o+red m+(+s e#(h d

Sym-tom#ti(#**y, #ffe(ted -erso$s -rod+(e more s-+t+m'

Fi%' 3 M#r!ed*y di*#ted )ro$(hi #re see$, some ith #ir4f*+id *eve*s &ye**o #rros6, most*y i$ the ri

*+$%' Chest r#dio%r#-hs3 Demo$str#te thi$4#**ed, (ysti( str+(t+res i$ ri%ht *oer *o)e &hite #rro6, so

ith #ir4f*+id *eve*s &ye**o #rros6'

Fi%' 3 This CT s(#$ de-i(ts #re#s of

)oth (ysti( )ro$(hie(t#sis #$d v#ri(o

)ro$(hie(t#sis'

Cysti( #$d (y*i$dri(#* )ro$(hie(t#sis

the ri%ht *oer *o)e o$ # -osterior4

#$terior (hest r#dio%r#-h'

Fi%' 3 Di#%r#m shoi$%

mor-ho*o%i(#* (h#$%es i$ the #ir#ys'

A' Congenital causes of bronchiectasis

i' Cysti( fi)rosis &is # (ommo$ re(essive %e$eti( dise#se hi(h #ffe(ts the e$tire )ody, (#+s

-ro%ressive dis#)i*ity#$d ofte$ e#r*y de#th'6

http://en.wikipedia.org/wiki/Recessivehttp://en.wikipedia.org/wiki/Genetic_diseasehttp://en.wikipedia.org/wiki/Bodyhttp://en.wikipedia.org/wiki/Disabilityhttp://en.wikipedia.org/wiki/Deathhttp://en.wikipedia.org/wiki/Recessivehttp://en.wikipedia.org/wiki/Genetic_diseasehttp://en.wikipedia.org/wiki/Bodyhttp://en.wikipedia.org/wiki/Disabilityhttp://en.wikipedia.org/wiki/Death

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ii' =#rt#%e$er sy$drome &rimary ciliary dyskinesia6

iii' Yo+$%/s sy$drome3 # r#re (o$ditio$ th#t e$(om-#sses # (om)i$#tio$ of sy$dromes s+(h

)ro$(hie(t#sis, rhi$osi$+sitis #$d red+(edferti*ity'

iv' A*-h#424#$titry-si$ defi(ie$(y3 #$ #+tosom#* (odomi$#$t %e$eti( disorder (#+sed )y defe(t-rod+(tio$ of #*-h# 24#$titry-si$ &A2AT6, *e#di$% to de(re#sed A2AT #(tivity i$ the)*ood#$d *+$

#$d de-ositio$ of e7(essive #)$orm#* A2AT-rotei$ i$*iver(e**s'

B' !c"uired causes of bronchiectasis

i' Re(+rre$t i$fe(tio$

ii' As-ir#tio$ of forei%$ )odies or other m#teri#*s

iii' I$h#*#tio$ of to7i( %#ses *i!e #mmo$i#

iv' A*(oho* #$d dr+% #)+se

v. T+)er(+*osis

Hoever, it (#$ o((+r ith $o o)vio+s (#+se for it &idioathic)# This is the (#se i$ #)o+t 9 of (#ses'

SYMPTOMS

Sym-toms of Bro$(hie(t#sis i$(*+de

Chro$i( (o+%h

I$(re#sed s-+t+m -rod+(tio$,

P+r+*e$t s-+t+m &)+t 29459 h#ve # dry (o+%h6 &Ch#$ et #*, 59956

orse he$ *yi$% do$ &A;A, 592

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Us+#**y the m+(+s is (*e#r, )+t it m#y )e )*oody d+e to )ro$(hi#* #** i$+ry or %ree$

ye**o if i$fe(tio$ is -rese$t' It m#y )e m#ssive de-e$di$% o$ the e7te$t of i$+ry

Short$ess of )re#th

e#!$ess #$d e#sy f#ti%#)i*ity'

DIAGNOSIS

Di#%$osis of Bro$(hie(t#sis )e%i$s ith the re*ev#$t -#tie$ts history#$dhysical e$amination# Medi

i$vesti%#tio$s i** he*- (o$firm di#%$osis' The i$divid+#* m#y comlain of d#i*y (o+%h #$d s-+t+

-rod+(tio$ th#t m#y or m#y $ot )e )*oody &due to damage to the bronchial tubes or from infection% m

be green or yellow if infection is resent6' This m#y or m#y $ot )e -re(eded )y # f*+4*i!e i**$ess' Short$

of )re#th ith #(tivity or #t rest, hee8i$%, f#ti%+e, #$d (hest -#i$m#y #*so )e e7-erie$(ed

Physical e$amination m#y )e re*#tive*y $orm#*' Us+#**y, on auscultation there m#y )e hee8es #

(r#(!*es i$ the *+$%s' De-e$di$% +-o$ the severity of dise#se #$d ho *o$% it h#s )ee$ -rese$t oth

findingsm#y i$(*+de ei%ht *oss, (y#$osis &of the s!i$ #$d the m+(o+s mem)r#$es due to an insufficie

level of o$ygen6, ri%ht he#rt f#i*+re &m#$ifested )y short$ess of )re#th, *e% se**i$%, #$d *iver e$*#r%eme$t

A hi%h reso*+tio$ (hest CT s(#$i** he*- (o$firm the di#%$osis' The CT m#y #*so he*- i$ fi$di$%

+$der*yi$% re#so$ hy Bro$(hie(t#sis deve*o-ed' P*#i$ (hest J4r#ysm#y )e +sed i$ he*-i$% m#!e t

di#%$osis #$d he*- tr#(! the -ro%ressio$ of the dise#se, )+t these fi$di$%s #re ofte$ m+(h more s+)t*e th

those see$ )y CT s(#$s' Bro$(hos(o-yis sometimes do$e to dete(t t+mors or forei%$ )odies th#t m#y h#

)ee$ see$ o$ CT'

&adiograhic features

A' P*#i$ fi*m

Chest 74r#ys #re +s+#**y #)$orm#*, )+t #re i$#de.+#te i$ the di#%$osis or .+#$tifi(#tio$ of )ro$(hie(t#s

'ram(track oacities #re see$ i$ (y*i$dri(#* )ro$(hie(t#sis, #$d #ir4f*+id *eve*s m#y )e see$ i$ (ys)ro$(hie(t#sis' Over#** there #--e#rs to )e #$ i$(re#se i$ )ro$(hov#s(+*#r m#r!i$%s, #$d )ro$(hi see$ e

o$ m#y #--e#r #s ri$% sh#dos' P+*mo$#ry v#s(+*#t+re #--e#rs i**4defi$ed, tho+%ht to re-res

-eri)ro$(hov#s(+*#r fi)rosis'

B' Com-+teri8ed Tomo%r#-hy

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CT #$d HRCT #re #)*e to disti$%+ish some of the v#rio+s +$der*yi$% (#+ses, to # %re#ter or *esser de%ree'

Noteorthy CT fi$di$%s i$ )ro$(hie(t#sis i$(*+de the fo**oi$%3

Cy*i$dri(#* )ro$(hie(t#sis h#s -#r#**e* tr#m tr#(! *i$es, or it m#y h#ve # si%$et4ri$% #--e#r#$(e

(om-osed of # di*#ted )ro$(h+s (+t i$ # hori8o$t#* se(tio$ ith #$ #d#(e$t -+*mo$#ry #rtery

re-rese$ti$% the sto$e

The di#meter of the )ro$(h+s *+me$ is $orm#**y 242' times th#t of the #d#(e$t vesse* # di#meter

%re#ter th#$ 2' times th#t of the #d#(e$t vesse* s+%%ests )ro$(hie(t#sis

#ri(ose )ro$(hie(t#sis h#s irre%+*#r or )e#ded )ro$(hi, ith #*ter$#ti$% #re#s of di*#t#tio$ #$d

(o$stri(tio$

Si%$s des(ri)ed o$ CT i$(*+de3

tr#m4tr#(! si%$

si%$et ri$% si%$

stri$% of -e#r*s si%$:

(*+ster of %r#-es si%$

Cy*i$dri(#* )ro$(hi h#ve # +$iform (#*i)re, do $ot t#-er #$d h#ve -#r#**e* #**s &tr#m tr#(! si%$#$d si%$e

ri$% si%$6

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J4r#y Co$%e$it#* (ysti( )ro$(hie(t#sis

Co$%e$it#* (ysti( )ro$(hie(t#sis ith m+*ti-*e #ir f*+id *eve*s

edical tests s+(h #sB*ood tests #$d s-+t+m tests m#y )e i$di(#ted de-e$di$% +-o$ the (*i$i(#* sit+#tio

Ser+m imm+$o%*o)+*i$s &I%G, I%A, I%M6 #$d ser+m e*e(tro-horesis ser+m I%E, s!i$ -ri(! testi$% or ser

I%E testi$% toAspergillus fumigatus #$dAspergillus precipitins'S-+t+m tests is do$e to dete(t the -rese$

of )#(teri# or f+$%i'

!*!+,,*'

Bro$(hie(t#sis is $ot # (+r#)*e dise#se' B+t ith -ro-er tre#tme$t most -eo-*e ith the dise#se (#$ h#v

%ood .+#*ity of *ife' The %o#* of tre#tme$t i** therefore )e to (o$tro* of se(retio$s #$d -reve$t

i$fe(tio$s' edical#$dPhysiotheray i$terve$tio$s he$ (om)i$ed ith ed+(#tio$ i** )e$efit the -#tie

edical

!ntibioticsm#y )e -res(ri)ed to tre#t #$ i$fe(tio$ th#t o((+rs or they m#y )e +sed as rohyla$is

-reve$t i$fe(tio$'

Bro$(hodi*#tor &e'%'#*)+tero*#$d #$ti(ho*i$er%i( dr+%s s+(h #s i-r#tro-i+m#$d tiotro-i+m6 +s+#

#s i$h#*ed medi(#tio$s di*#te )ro$(hi#* t+)es #$d i$(re#se #ir f*o i$to the *+$%s, m#!i$% it e#sier

se(retio$s to )e (*e#red'

O$ygen sulementation

Advi(e o$ )#si( *+$% hy%ie$e is re.+ired for -#tie$ts ith )ro$(hie(t#sis3

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=ee- imm+$i8#tio$s +- to d#te to -reve$t i$fe(tio$s'

Dri$! -*e$ty of f*+ids to m#!e m+(o+s se(retio$s *ess sti(!y'

Sto- smo!i$% #$d #void -#ssive smo!i$%'

Get #de.+#te $+tritio$ )y (o$s+mi$% $e(ess#ry (#*ories' For some -eo-*e, )re#thi$% re.+i

i$(re#sed effort #$d th+s #$d re.+ires i$(re#sed$+tritio$'

Surgery( here the dise#se is *imited to o$e #re# of the *+$%, m#y )e # -ossi)i*ity to remove the #

#ffe(ted )y the dise#se'

PHYSIOTHERAPY

This +s+#**y i$vo*ves (om)i$#tio$ of ed+(#tio$, #ero)i( e7er(ise, #ir#y (*e#r#$(e i$terve$tio$s, )ody

-ositio$i$%, re*#7#tio$ #$d e$er%y (o$serv#tio$'Chest hysical theray assists in coughing u secretion

&+si$% ercussion or claingto he*- loosen secretions) #$d Posturaldrainage he*-s to #**o %r#vity to

he*- those se(retio$s to )e (o+%hed +-'6

The #ims of -hysiother#-y sho+*d i$(*+de3

i' To ed+(#te o$ the $#t+re of the (o$ditio$ #$d se*f4m#$#%eme$t, $+tritio$, ei%ht (o$tro*, smo!i

red+(tio$ #$d (ess#tio$, medi(#tio$s #$d their +se #$d i$fe(tio$ (o$tro*

ii' To f#(i*it#te m+(o(i*i#ry tr#$s-ort

iii' To o-timi8e se(retio$ (*e#r#$(e

iv' To o-timi8e #*veo*#r ve$ti*#tio$

v' To o-timi8e *+$% vo*+mes #$d f*o r#tes

vi' To o-timi8e ve$ti*#tio$ #$d ve$ti*#tio$ -erf+sio$ r#tio

vii' To red+(e the or! of )re#thi$%

viii' To m#7imi8e #ero)i( (#-#(ity #$d tr#$s-ort of o7y%e$

i7' To o-timi8e -hysi(#* e$d+r#$(e #$d e7er(ise (#-#(ity

7' To o-timi8e %e$er#* m+s(*e stre$%th #$d there)y o7y%e$ e7tr#(tio$

Physi(#* ther#-y tre#tme$ts m#y i$(*+de3

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#' A(tive Cy(*e of Bre#thi$% Te(h$i.+e &ACBT6

)' For(ed e7-ir#tory te(h$i.+e &FET6 >Co+%h #$d h+ffi$%?

(' Per(+ssio$ -Me(h#$i(#* devi(es s+(h #s (hest (*#--ers or vests #*so m#y )e (o$sidered'6

d' Sh#!i$% #$d vi)r#tio$

e' Post+r#* dr#i$#%e

Comlications

a# Pulmonary .yertension/ de(re#sed o7y%e$ *eve* over time (#+ses (o$stri(tio$ of the -+*mo$#

#rteries, res+*ti$% i$ i$(re#sed -ress+re i$ these #rteries' Over(omi$% these -ress+res for(es the he

to or! h#rder (#+si$% the ri%ht ve$tri(*e to thi(!e$, # (o$ditio$ (#**ed cor ulmonale&eve$t+#

the ri%ht side of the he#rt &hi(h -+m-s )*ood to the vesse*s of the *+$%6 m#y f#i*, res+*ti$%

i$(re#sed f*+id #((+m+*#tio$ i$ the *e%s or #)domi$#* (#vity6'

)' .emotysis&he$ there is i$+ry of the )ro$(hi#* #**6

(' Re(+rre$tPneumonia

d' .eart failure and resiratory failure #re the (ommo$ (#+ses of de#th i$ -#tie$ts

)ro$(hie(t#sis'

Prognosis

The o+t*oo! de-e$ds +-o$ the +$der*yi$% re#so$ for deve*o-i$% )ro$(hie(t#sis' Congenital causes

bronchiectasis/ like cystic fibrosis/ may have a worse rognosis than ac"uired disease

E#r*y re(o%$itio$ #$d #de.+#te tre#tme$t (#$ he*- (o$tro* )ro$(hie(t#sis #$d de(re#se sym-toms' ;ife4 *o

##re$ess of the $eed for tre#tme$t m#y #**o -eo-*e ith )ro$(hie(t#sis to mi$imi8e (om-*i(#tio$s #

m#7imi8e *ife e7-e(t#$(y'

CASE STUDY

BIODATA

N#me3 Y M

Se73 Fem#*e

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A%e3

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5' Co#rse (re-it#tio$ he#rd i$ the midd*e 8o$e of the *eft *+$%s

O$ r#dio%r#-h?

Clinical imression3 Bro$(hie(t#sis of the *eft *+$% &idio-#thi(6

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Plan3

2' To i$(re#se #ir#y (*e#r#$(e

5' To im-rove the (#rdio-+*mo$#ry system i$te%rity

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ay 5(6

St#irs (*im)i$% #dded to #rd -ro%r#mme

S-+t+m -rod+(tio$ #s +$der 59 4 9m*Ld#y

Tre#tme$t i$(*+ded ACBT, FET, I$(e$tive s-irometry, #rd -ro%r#mme

ay 78 to 74

S-+t+m -rod+(tio$ #s +$der 59m*Ld#y' It #s m+(h *ess fo* sme**i$%, #$d (*e#r &hite6

Tre#tme$t i$(*+ded ACBT, FET, I$(e$tive s-irometry, Aero)i( e7er(ised, #rd -ro%r#mme

P#tie$t #*!ed 9m i$ si7 mi$+tes o$ d#y 29'

3rdweek

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