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Cardiorespiratory case commentary In ‘normally’ functioning lungs drainage of the bronchial tree is efficiently achieved by cillary action and by expiratory contraction of the bronchial muscle, which propels secretions towards the trachea (Cole & Mackay 1990). Ms. X has a chronic suppurative lung disease called bronchiectasis, which Cole, (1990) defines as ‘the irreversible dilation of one or more of the bronchi often accompanied by the chronic production of sputum’. The chronic dilation of the bronchi impairs the drainage of bronchial secretions and leads to persistent infection in the affected segment or lobe. Aetiology and pathogenesis The aetiology of bronchiectasis isn’t fully understood; some theories suggest that it could be congenital, (Barker, 2002). The currently accepted theory and the most common is that it is acquired resulting from (1) mechanical airway obstruction, (2) abnormal mucous production and (3) infection. (www.projectlinks.com). In Ms. Xs case, the likely cause of her exacerbation is the presence of haemophillius influenza. Bronchiectasis is associated with a broad spectrum of disease severity. In mild cases there may be no symptoms except during exacerbations, however in more severe disease, continual production of purulent secretions is accompanied by coughing and breathlessness. Ms X has been admitted with increased shortness of breath (SOB) and increased expectoration suggesting that normally Ms X does suffer from SOB and expectorations advocating that her condition is quite advanced. Many authors say that the best way of explaining the pathogenesis of bronchiectasis is that of a ‘vicious circle’ of chronic inflammatory events occurring as a result of reduced microcillary clearance leading to host mediated tissue damage (Cole, 1990). INITIAL INSULT (H.Influenza) IMPAIRED MUCOCILLIARY CLEARANCE BACTERIAL Bronchiectasis TISSUE DAMAGE COLONISATION INFLAMMATION (Cole 1985) Ms X’s initial insult being the influenza infection results in increased mucous production. The cilia within Ms X are unable to clear the mucus away, which leads to bacteria colonising.
Approximate Word count = 1168
Approximate Pages = 4.7
(250 words per page double spaced)
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