Bronchiectasis

Bronchiectasis | Infectious causes | Non-infectious causes | Symptoms and consequences | Diagnosis | Course of illness | Bronchiectasis treatments | Conclusion

Bronchiectasis

Bronchiectasis, whether diffused or localized, it is a chronic lung disorder, usually caused by repeated respiratory infections. It is characterized by a permanent and irreversible enlargement (dilatation) of the bronchial tubes and/or bronchioles.

The transformation of the bronchial tubes and poor performance of the cilia (tiny hairs that line the inner wall of the bronchial tubes) causes the production of large amounts of mucus, thus respiratory infections to increase, thereby triggering a vicious circle that further destroys the airways.

Infectious causes

• Acute recurring bronchitis
• Tuberculosis
• Pertussis
• Lung abscess
• Various pulmonary diseases

Non-infectious causes

• Congenital malformation
• Mucoviscidosis (hereditary disease producing extremely thick mucus)
• Immunological deficiency such as cystic fibrosis
• Bronchial obstruction due to foreign matter or a benign tumor

Symptoms and consequences

Bronchiectasis often develops during early childhood, as a result of repeated and poorly treated respiratory infections. However, it can develop at any age.

The main symptom is a chronic cough producing a large quantity of clear or coloured secretions (yellow or green) depending on infectious agents.

As the bronchiectasis progresses or becomes more severe, other symptoms may also appear, such as:

• Purulent secretions and foul odours
• Dyspnea (shortness of breath)
• Hemoptysis (blood in the sputum)
• Sinusitis
• Lung abscess
• Digital hippocratism (clubbing of the fingers caused by a chronic lack of oxygen)

Diagnosis

A bronchiectasis diagnosis may often be suspected based on a history of infectious respiratory diseases during childhood.

During auscultation, the health professional can hear abnormal bronchial sounds such as rales or ronchi.

X-ray examinations are sometimes revealing, while a CAT scan of the chest shows the precise dilatation of the bronchial tubes and the extent of the disease.

Bronchoscopy can be useful in locating foreign matter or obtaining a specimen for analysis, as in the case of a purulent respiratory infection.

The Pulmonary Function Test is very useful in measuring an individual's lung capacity and volumes. Furthermore, an analysis of the sputum may be required to identify specific bacteria and viruses or to determine the causes of a persistent sinusitis.

Course of illness

If the bronchial disorder is localized, the course of illness is usually benign, while respiratory infections are less frequent and heal well.

If the bronchiectasis is diffused, i.e. spread to a large portion of the lung, bronchial infections (pneumonia or pulmonary abscess) are more frequent and hard to treat.

The coughing up of blood from the respiratory tract (hemoptysis) is not uncommon and can speed up the course of illness.

Occasionally, in very advanced cases of bronchiectasis, respiratory distress may necessitate the use of oxygen.

Bronchiectasis treatments

Treatment is primarily preventive:

• Smoking cessation
  It is absolutely essential that patients quit smoking in order to slow down the deterioration and destruction of bronchial tissue. Furthermore, it is important to avoid all other respiratory irritants.

• Vaccination
  Influenza (flu) and pneumococcal (pneumonia) vaccination is strongly recommended.

• Bronchial decongestion
  In patients with widespread bronchiectasis, postural drainage and/or chest clapping are essential prophylactic and treatment methods of respiratory complications. These gravity relying techniques facilitate the drainage of mucus and can be performed several times a day. In addition to maintaining overall fitness, physical exercise promotes ventilation, coughing and phlegm production by loosening the mucus. Flutter, Tera-pep or Acapella - type instruments can sometimes be used to produce vibrations and a form of expiratory resistance which can facilitate mucus decongestion.

• Hydration and diet
  A proper daily intake of liquids and a healthy diet promote well-being and provide needed energy.

• Pharmacotherapy
  The treatment of infections calls for the use of antibiotic therapy and bronchodilators and may include inhaled corticosteroides. Occasionally, mucolytics may be administered in aerosol form to liquefy and help loosen the mucus. Oxygen therapy may be considered as a means of relieving respiratory distress, in cases of chronic hypoxemia.

Conclusion

In most cases, bronchiectases is restricted to a specific area of the lungs, few symptoms will be present and is usually non-progressive. For the most part, only those who suffer from the widespread and more generalized form of bronchiectasis will develop symptoms.

In the pure and severe forms, there is often a long history of repeated respiratory infections with an abundant quantity of sputum production becoming chronic, sometimes purulent and sometimes blood-streaked.

Bronchiectasis is now much less common than it once was. This probably reflects modern antibiotic treatments of respiratory infections as well as more early.