bronchiectasis
BRONCHIECTASIS
Bronchiectasis is an irreversible pathologic dilatation or ectasia of the bronchi due to repeated airway infection and inflammation.
It enhances susceptibility to bronchial infection and increases inflammatory reaction which causes further lung damage.
Classic symptoms of of bronchiectasis are cough with chronic sputum production along with recurring infective exacerbations and hemoptysis.

Surgical Intervention

  • Surgery should be confined to patients w/ failed medical treatment, localized & troublesome disease
  • Recurrence of cough & sputum production in the remaining bronchial tree often occurs or recurrent hemoptysis
Goals of Surgery
  • Foreign body or tumor removal
    • Surgical or bronchoscopic
  • Removal of lobes or segments of disease that are the most damaged & may be contributing to acute exacerbations
  • Removal of overwhelming viscous secretions, mucous impaction or plugs
  • Control of hemoptysis
  • Removal of multi-drug resistant MAC or Aspergillus sp infection
Lung Resection
  • May be considered in patients w/ localized disease & frequent exacerbations who were deemed unresponsive to medical & nonpharmacologic treatment
  • Indications include:
    • Therapeutic failure after 1 year of medical treatments
    • Severe or frequent exacerbations w/ significant impact in patient’s quality of life
    • Recurrent refractory or massive hemoptysis (>600 mL/day)
    • Bronchiectasis due to obstruction secondary to a tumor
    • Presence of localized severely damaged, nonfunctional pulmonary lobe or segment that may cause sepsis & further lung damage
  • Preferred management option for patients w/ massive hemoptysis refractory to bronchial artery embolization
  • Video-assisted thoracoscopic surgery (VATS) is preferred over open surgery due to lower complication rates, better preservation of lung function, & shorter days of hospitalization
Lung Transplantation
  • May be considered in elderly patients (>65 years) or in patients w/ FEV1 <30% w/ unstable lung function despite aggressive medical treatment
  • Patients w/ massive hemoptysis, severe secondary pulmonary hypertension, diffuse bilateral disease, or respiratory failure may be considered for lung transplantation
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