learning支气管扩张症学习课件

Bronchiectasis,Definition,Permanent dilatation of one or more bronchi Elastic and muscular tissue of bronchial walls destroyed by acute and chronic infection Impaired drainage of secretions Secretions chronically infected Chronic inflammatory response Progressive destructive lung disease,Bronchiectasis,Common causes,Clinical features,Totally asymptomatic to severe disease Productive cough with large amounts of purulent secretions, sometimes haemoptysis Frequently admitted to hospital Exacerbations chest pain, dyspnoea, fever If accompanied by CF or PCD sinus disease with nasal blockage, purulent discharge, and facial pain Auscultation coarse crepitations, wheezing Usually no clubbing,Diagnosis and investigations,Assessment X-ray CT Sputum specimen Bronchoscopy Lung function Serum immunoglobulins ABPA Gene mutation analysis Electron microscopy,Medical management,Physiotherapy Antibiotics Oral, intravenous, nebulized,Clearance of infected secretions,Treating infections,Other treament measures,Influenza vaccination Treatment of rhinosinusitis Immunoglobulin replacement therapy Surgical resection Inhaled human deoxyribonuclease (rhDNase) Inhaled steroids and bronchodilators,physiotherapy,Problems: Excess bronchial secretions Dyspnoea exercise tolerance Chest wall pain (musculoskeletal),Excess bronchial secretions,Patient must understand pathology and reason for treatment ACBT, AD, Flutter Becareful of head-down tip - GOR Self treatment important daily Time of day? Physio techniques reassessed Improved ventilation Hypertonic saline,Acute exacerbation,Hospitalised - secretions or more purulent, dehydrated, dyspnoea. Haemoptysis and pleuritic pain Nebulized bronchodilator and humidification IPPB - work of breathing Post-resection changed anatomy of bronchial tree find optimal position Blood streaking in sputum continue Rx. Frank haemoptysis discontinue Continue Rx when secretions mildly bloodstained,Dyspnoea Exercise tolerance,Inhalation with bronchodilator Relaxation positions and breathing control,Exercise to fitness and secretions Group pulmonary rehab programme IMT,Chest wall pain - musculoskeletal,Anti-inflammatory drugs and analgesics Heat IF TENS Acupuncture Manual therapy,Evaluation of physiotherapy,Effective tr