What Is Bronchiectasis?
Bronchiectasis is an uncommon disorder that affects the lungs. In this condition, the bronchial tubes become enlarged and distended forming pockets, or pouches where infection may gather. The walls of the bronchial tubes become damaged, which interferes with the lung’s complex cleaning system. Tiny hairs, called cilia are destroyed. Normally, cilia line the bronchial tubes and sweep them free of dust, germs and excess mucus. When this cleaning system is damaged, dust, mucus, bacteria, and other foreign substances accumulate. This may lead to chronic infection in areas of the lung affected by bronchiectasis.
What Are The Causes of Bronchiectasis?
Bronchiectasis is often caused by chronic inflammation or repeated infections of the airways. It may be present at birth, but most often it begins in childhood as a complication from infection or inhaling a foreign object. In the United States, about 50% all bronchiectasis is caused by cystic fibrosis.
Various types of lung infections may damage and weaken the bronchial walls and interfere with the action of the cilia. These may include severe pneumonia, tuberculosis, and fungal infections of the lungs. Pneumonia due to measles and whooping cough may predispose a child to bronchiectasis by weakening the walls of the bronchial tubes and causing pockets of infection to form.
People with an immunologic deficiency, such as AIDS, are more likely to have chronic or repeated lung infections, and are prone to develop bronchiectasis.
Rarely, a child may inherit an abnormality of the hair cells or cilia which makes it more likely for the child to develop bronchiectasis.
An obstruction of some sort, which presses on the bronchial tubes from the outside (such as a tumor) or blocks them from the inside (such as a piece of food), may cause bronchiectasis. In childhood (and in some elderly people) this most commonly results from choking on food (such as a peanut), which is small enough to go down the windpipe and large enough to block off one of the bronchial tubes. When this happens the wall of the tube is injured and air is prevented from getting past the obstruction. The bronchial tube, below the obstruction, then may balloon out to form a place that can easily get infected.
What Are The Symptoms of Bronchiectasis?
The symptoms of bronchiectasis often develop gradually, and may occur months or years after the event that caused the condition.
The main symptom of bronchiectasis is a cough. Coughing occurs especially when lying down because of the accumulation of mucus. People with bronchiectasis cough up large amounts of foul-smelling sputum, which may resemble green or yellow pus. The sputum may also contain blood.
Although some people with bronchiectasis feel generally well, except for coughing, others with the condition may have shortness of breath, weight loss, fatigue, and wheezing.
How Is Bronchiectasis Diagnosed?
As part of the evaluation for a chronic cough, a doctor will perform a complete medical history and physical examination. Using a stethoscope, the doctor may hear small clicking, bubbling, rattling, or other sounds, usually in the lower lobes of the lungs of people with bronchiectasis. The doctor may then recommend tests to diagnosis brochiectasis and to determine the cause of the condition. These may include:
How is Bronchiectasis Treated?
The goal of bronchiectasis treatment is to prevent complications and provide relief of symptoms. It is also important to treat the underlying cause of bronchiectasis and take measures to prevent infections. Treatment consists of controlling infections and bronchial secretions, and relieving airway obstruction.
Regular, daily drainage to remove bronchial secretions is a routine part of treatment for bronchiectasis. A respiratory therapist can teach postural drainage and effective coughing exercises to people with the condition and their families.
Medications include antibiotics, which may be used to treat infections and bronchodilators, which are used to help keep the airways open.
People with bronchiectasis who fail to respond to therapy or develop massive bleeding may need to have lung surgery to remove the diseased part of the lung. If the condition is widespread, the individual may be a candidate for a lung transplant.
How Can Bronchiectasis Be Prevented?
Bronchiectasis much less common than it once was. This probably reflects the availability of antibiotics to treat respiratory infections as well as a better understanding of how to manage cystic fibrosis.
Most bronchiectasis develops in childhood, but the vast majority of these cases can now be prevented by the:
- Use of immunizations to protect against infections
- Appropriate treatment of respiratory infections
- Prompt removal of foreign bodies which have entered the bronchial tree
Preventive measures in adults include flu and pneumococcal vaccination, avoiding respiratory infections, not smoking, and avoiding pollution.
For people who already have bronchiectasis, daily postural drainage and chest clapping, judicious use of antibiotics, avoidance of cigarette smoke, and flu and pneumococcal vaccination, may all help to prevent the condition from getting worse.
With appropriate treatment and preventive measures, most people with bronchiectasis can lead normal lives without major disability.