Bronchiectasis is serious!Bronchiectasis is a form of chronic obstructive pulmonary disease (COPD) .It is a lung condition in which the airways to the lungs are damaged making it abnormally wide,scarred and thickened.This extra space allows bacteria and mucus to build up causing recurrent infections and leading to the blockages of airways.
Bronchiectasis in Detail
When we breathe, air is carried into lungs through our airways, also called bronchi. The bronchi divide into thousands of smaller airways called bronchioles which contain tiny glands that produce mucus.Mucus is a slimy substance that helps to keep airways moist and traps the dust and germs that are inhaled.The mucus is moved away by tiny hairs, called cilia, which line the airways.
In bronchiectasis, airways are scarred and inflamed with thick mucus, also called phlegm or sputum,airways slowly lose their ability to clear out mucus. When mucus can’t be cleared, it builds up and creates an environment in which more bacteria are breathed in.Bacteria grows in the excess mucus, leading to repeated, serious lung infections.Each infection causes more damage to your airways ,the breathing tubes become baggy and holes form in the lungs.. Over time, the airways lose their ability to move air in and out preventing enough oxygen from reaching your vital organs.This can ultimately lead to the loss of lung function over time, as well as serious health problems such as respiratory failure,heart failure and atelectasis.
Causes
Bronchiectasis can be congenital resulting from an abnormal lung development before birth. Bronchiectasis usually begins with some type of lung damage which might have been caused by a common childhood infection such as whooping cough or measles, or from a lung-related medical condition such as cystic fibrosis or primary ciliary dyskinesia.There are two main categories of this condition. One is related to having cystic fibrosis and is known as CF bronchiectasis. CF is a hereditary condition that causes an abnormal production of mucus.The other category is non-CF bronchiectasis, which isn’t related to CF.
Bronchiectasis can develop in the following conditions:
- Humoral immunodeficiency (low levels of infection-fighting proteins in the blood)
- Inflammatory bowel disease (Crohn’s disease and ulcerative colitis)
- Rheumatologic diseases (rheumatoid arthritis and Sjögren’s disease)
- Alpha1-antitrypsin deficiency (genetic cause of COPD in some people)
- Chronic obstructive pulmonary disease or COPD
- HIV infection
- Allergic bronchopulmonary aspergillosis (a type of allergic lung inflammation)
- pneumonia
- Whooping cough or measles
- Tuberculosis
- Fungal infection
Symptoms
The most common signs and symptoms of bronchiectasis are:
- A daily cough that occurs over months or years
- Daily production of large amounts of sputum (spit). Sputum, which you cough up and spit out, may contain mucus (a slimy substance), trapped particles, and pus.
- Shortness of breath and wheezing (a whistling sound when you breathe)
- Chest pain
- Clubbing (the tissue beneath the nail thickens and the fingertips become rounded and bulbous)
- Fatigue which is profound
Diagnosis
If your doctor listens to your lungs with a stethoscope, he or she may hear abnormal lung sounds.
Some tests that aid in the diagnosis include:
- Chest x-ray: A chest x-ray may show some signs of the disease, but other tests (such as a CT) are usually needed to confirm or refute the diagnosis.
- Chest CT scan: The diagnosis is usually made based on the appearance of a CT scan.
- Pulmonary function tests can help with the diagnosis as well as the severity.
- A bronchoscopy may be done to rule out a foreign body or lung cancer.
Treatment
The goals of treatment are to:
- Treat any underlying conditions and lung infections.
- Remove mucus (a slimy substance) from your lungs. Maintaining good hydration helps with mucus removal.
- Prevent complications.
Early diagnosis and treatment of the underlying cause of bronchiectasis may help prevent further lung damage. In addition, any disease associated with the bronchiectasis, such as cystic fibrosis or immunodeficiency, also should be treated.
Medicines
Your doctor may prescribe antibiotics, bronchodilators, expectorants, or mucus-thinning medicines to treat bronchiectasis.
Antibiotics
Antibiotics are the main treatment for the repeated lung infections that bronchiectasis causes. Oral antibiotics often are used to treat these infections.For hard-to-treat infections, your doctor may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line inserted into your arm. Your doctor may help you arrange for a home care provider to give you IV antibiotics at home.Expectorants and Mucus-Thinning MedicinesYour doctor may prescribe expectorants and mucus thinners to help you cough up mucus.
Expectorants help loosen the mucus in your lungs. They often are combined with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.
Hydration
Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery, which makes it easier to cough up.
Chest Physical Therapy
CPT also is called physiotherapy (FIZ-e-o-THER-ah-pe) or chest clapping or percussion. This technique is generally performed by a respiratory therapist but can be done by a trained member of the family. It involves the therapist pounding your chest and back over and over with his or her hands or a device. Doing this helps loosen the mucus from your lungs so you can cough it up.You can sit with your head tilted down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people find CPT hard or uncomfortable to do. Several devices can help with CPT, such as:
- An electric chest clapper, known as a mechanical percussor.
- An inflatable therapy vest that uses high-frequency air waves to force mucus toward your upper airways so you can cough it up.
- A small handheld device that you breathe out through. It causes vibrations that dislodge the mucus.
- A mask that creates vibrations to help break loose mucus from your airway walls.
Some of these methods and devices are popular with patients and doctors, but little information is available on how well they actually work. Choice usually is based on convenience and cost.
Several breathing techniques also are used to help move mucus to the upper airway so it can be coughed up. These techniques include forced expiration technique (FET) and active cycle breathing (ACB).FET involves forcing out a couple of breaths and then doing relaxed breathing. ACB is FET that involves deep breathing exercises.
Other Treatments
Depending on your condition, your doctor also may recommend bronchodilators, inhaled corticosteroids, oxygen therapy, or surgery.
Bronchodilators
Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are inhaled medicines. You will use an inhaler or a nebulizer to breathe in a fine mist of medicine.Inhaled bronchodilators work quickly because the medicine goes straight to your lungs. Your doctor may recommend that you use a bronchodilator right before you do CPT.
Inhaled Corticosteroids
If you also have wheezing or asthma with your bronchiectasis, your doctor may prescribe inhaled corticosteroids (used to treat inflammation in the airways).
Oxygen Therapy
Oxygen therapy can help raise low blood oxygen levels. For this treatment, you’ll receive oxygen through nasal prongs or a mask. Oxygen therapy can be done at home, in a hospital, or in another health facility.
Surgery
Your doctor may recommend surgery if no other treatments have helped and only one part of your airway is affected. If you have major bleeding in your airway, your doctor may recommend surgery to remove part of your airway or a procedure to control the bleeding.In very rare instances of severe bronchiectasis, your doctor may recommend that you receive a lung transplant replacing your diseased lungs with a healthy set of lungs.
To prevent bronchiectasis, it’s important to prevent the lung infections and lung damage that can cause it.Childhood vaccines for measles and whooping cough prevent infections related to these illnesses. These vaccines also reduce complications from these infections, such as bronchiectasis.Avoiding toxic fumes, gases, smoke, and other harmful substances also can help protect your lungs.Proper treatment of lung infections in children also may help preserve lung function and prevent lung damage that can lead to bronchiectasis.Stay alert to keep children (and adults) from inhaling small objects (such as pieces of toys and food that might stick in a small airway). If you think you, your child, or someone else has inhaled a small object, seek prompt medical care.In some cases, treating the underlying cause of bronchiectasis can slow or prevent its progression.
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