atelectasis vs bronchiectasis

atelectasis vs bronchiectasis

Atelectasis

Atelectasis is a condition in which all or part of a lung becomes airless and contracts. It may be acute or chronic.

Bronchiectasis

Bronchiectasis is an irreversible widening or dilation of portions of the airways or bronchi resulting from damage to the bronchial wall.

Causes

  • The most common cause is an obstruction of a large bronchus.
  • Smaller airways can also become blocked.
  • The obstruction may be caused by a plug of mucus, a tumor, or an inhaled foreign object inside the bronchus.
  • Bronchus may also be blocked by something pressing from outside such as a tumor, enlarged lymph nodes, or a significant amount of fluid (pleural effusion) or air in pleural space (pneumothorax).
  • When an airway becomes blocked, the air in the small air sacs of the lung (alveoli) beyond the blockage is absorbed into the bloodstream, causing the alveoli to shrink and retract.
  • The collapsed lung tissue commonly fills with blood cells, serum and mucus become infected.
  • Atelectasis can occur in jet fighter pilots when the high forces generated by high speed flying close small airways.
  • Atelectasis of this type is described as acceleration atelectasis, leading to the collapse of alveoli in a large portion of both the lungs.
  • Additionally, atelectasis can result if there is a deficiency in the amount of effectiveness of surfactant (liquid) that coats the lining of the alveoli.
  • Under normal circumstances, this liquid prevents the alveoli from collapsing.
  • Respiratory infections
    • Bacterial infections such as whooping cough or infections caused by Klebsiella, Staphylococcus, or Pseudomonas.
    • Fungal infection such as Aspergillosis.
    • Mycobacterial infection such as tuberculosis.
    • Viral infection such as influenza, adenoviral infection, respiratory syncytial virus infectionor measles.
    • Mycoplasma infection.
  • Bronchial obstruction
    • Inhaled object.
    • Enlarged lymph glands.
    • Lung tumor.
    • Mucus plug.
  • Inhalation injuries
    • Injury from noxious fumes, gases or particles.
    • Inhalation of stomach acid and food particles.
  • Hereditary conditions
    • Cystic fibrosis
    • Primary ciliary dyskinesia, including Kartagener’s syndrome
    • Marfan syndrome
  • Immunologic abnormalities
    • Immunoglobulin deficiency syndromes.
    • White blood cell dysfunction.
    • Complement deficiencies
    • Certain autoimmune or hyper-immune disorders such as rheumatoid arthritis and ulcerative colitis.
  • Other conditions
    • Drug abuse such as Heroin abuse.
    • HIV infection
    • Young’s syndrome (obstructive azoospermia)
    • Yellow nail syndrome (with lymphedema)

Symptoms

  • Shortness of breath due to loss of functioning of the lung tissue.
  • Increased heart rate and bluish appearance (sometimes) of the person due to persistent blood flow through the collapsed area leading to a decrease in blood oxygen level.
  • The severity of symptom depends on
    • How rapidly the bronchus is blocked.
    • How much of the lung is affected?
    • Precipitating factor.
    • Presence or absence of infection.
  • When blockage happens quickly and a lot of lung tissue is affected, the person may become blue or ashen in color, have sharp pain on the affected side and have sudden and extreme shortness of breath.
  • The person may also experience shock with a severe drop in blood pressure, a rapid heart rate and fever if infection develops.
  • Widespread atelectasis resulting from deficient or ineffective surfactant produces shortness of breath, rapid and shallow breathing, low blood oxygen levels and other symptoms depending on the cause of the acute lung injury. For example, fever and low blood pressure from sepsis and accompanying effects of low blood oxygen (such as abnormal heart rhythms) on organs other than lungs.
  • Slowly developing atelectasis may cause no symptoms or only minor ones such as shortness of breath or an increased heart rate.
  • People with middle lobe syndrome and rounded atelectasis may have no symptoms, although some people with middle lobe syndrome have a hacking cough or develop pneumonia that resolves slowly or incompletely.
  • Bronchiectasis can develop at any age of ten, the process begins in early childhood.
  • However, symptoms may not appear until much later.
  • In most people, symptoms begin gradually, usually after a respiratory infection and tend to worsen over the years.
  • Most people develop a chronic cough that produces sputum.
  • The amount and type of sputum depends on how extensive the disease is and whether there is complicating infection.
  • Often the person has coughing spells only early in the morning and late in the day.
  • Coughing up of blood is common and may be the first or only symptom.
  • Recurrent fever or chest pain, with or without frequent bouts of pneumonia, may also occur.
  • People with widespread bronchiectasis may develop wheezing or shortness of breath.
  • They may also have chronic bronchiectasis, which occur more commonly in underdeveloped countries and in people who have cystic fibrosis, may impair breathing and the lungs ability to oxygenate the blood and rid the body of carbon dioxide, a condition called respiratory failure.
  • Very severe bronchiectasis may also strain the right side of the heart and lead to cor pulmonale.

Diagnosis

  • Doctors suspect atelectasis based on a person’s symptoms, the physical examination findings, and the setting in which the symptoms occurred.
  • A chest X-ray that shows the airless area confirms the diagnosis, but the X-ray may appear normal even when the person is feeling breathless.
  • When bronchial obstruction is suspected, computed tomography, bronchoscopy, or both these tests may be performed to find the cause, especially when the collapse persists despite usual treatment measures.
  • Doctors may suspect bronchiectasis because of a person’s symptoms or the presence of a condition thought to cause bronchiectasis.
  • Tests are performed to confirm the diagnosis and assess the extent and location of the disease.
  • Chest X-rays can often detect the lung changes caused by bronchiectasis, however , occasionally results are normal.
  • Computed tomography is usually the most sensitive test to identify and confirm the diagnosis and to determine the extent and severity of the disease; these are important factors when surgical treatment is being considered.
  • After bronchiectasis is diagnosed, tests are often performed to check for diseases that may be causing or contributing to it if they were not previously identified.
  • Such tests may include measuring the immunoglobulin levels in blood, testing for HIV infection and other immune system disorders, measuring the salt levels in sweat (which are abnormal in people with cystic fibrosis) and examining nasal, bronchial or sperm specimens with a special microscope and other tests to determine if the cilia are structurally or functionally defective.
  • When bronchiectasis is limited to one area: for example, a lung lobe or segment – doctors may perform bronchoscopy to determine an inhaled foreign objector lung tumor is the cause.
  • Other tests may be performed to identify underlying diseases such as allergic bronchopulmonary aspergillosis or tuberculosis.
  • Genetic testing for cystic fibrosis may be needed when there is a family history, repeated respiratory infections, or other suspicious findings in a child or young adult, even when other features of typical cystic fibrosis are absent.

Treatment

  • The primary treatment for acute massive atelectasis is the correction of the underlying cause.
  • A blockage that can not be removed by coughing or by suctioning the airways often can be removed by bronchoscopy.
  • Antibiotics are given for an infection.
  • Chronic atelectasis is often treated with antibiotics because infection is almost inevitable.
  • In certain cases, the affected part of the lung may be surgically removed when recurring or chronic infections become disabling or bleeding is significant.
  • If a tumor is blocking the airway, relieving the obstruction by surgery, radiation therapy, chemotherapy, or laser therapy may prevent atelectasis from progressing and recurrent obstructive pneumonia from developing.
  • In the treatment of atelectasis due to deficient or ineffective surfactant, attention is directed at treating the low blood oxygen levels. This is often done with mechanical ventilation or positive end-expiratory pressure. This effects promptly and at identifying and treating the underlying condition.
  • Treatment with surfactant drug is life-saving for premature babies with a surfactant deficiency. Such therapy is experimental in adults with acute respiratory distress syndrome who have reduced surfactant activity.
  • Treatment of bronchiectasis is directed against eradicating infections, decreasing the buildup of mucus and inflammation, relieving airway obstruction and reducing complications such as coughing up of blood, low oxygen levels in the blood, respiratory failure and cor pulmonale.
  • Drugs that suppress coughing may worsen the condition and should not be used.
  • Infections are treated with antibiotics, bronchodilators and physical therapy to promote drainage of secretions.
  • Sometimes antibiotics are prescribed for a long period to prevent recurring infections, especially in people who have cystic fibrosis.
  • For inflammation and buildup of mucus, anti-inflammatory drugs such as inhaled corticosteroids and drugs that thin this pus and mucus may also be given, although the effectiveness of mucolytics is uncertain.
  • To help drain the mucus, postural drainage and chest percussion are used.
  • To detect and treat bronchial obstruction, bronchoscopy can be used before severe damage occurs.
  • Rarely, a part of a lung needs to be surgically removed.
  • Such surgery usually is an option only if the disease is confined to one lung, or preferably to one lung lobe or segment.
  • Surgery may be considered for people who have recurrent infections despite treatment or who cough up large amounts of blood.
  • Alternatively, a doctor may deliberately block a bleeding bronchial vessel by using a procedure called bronchial arterial embolization.
  • If the person’s blood oxygen level is low, oxygen therapy may help prevent complications such as cor pulmonale.
  • If the person has wheezing or shortness of breath, corticosteroids taken with or without bronchodilators often help.
  • Respiratory failure if present, should be treated.
  • Lung transplantation can be performed in certain people who have advanced bronchiectasis, mostly those who also have advanced cystic fibrosis.
  • Five years survival rates as high as 65 to 75% have been reported when a heart-lung or a double lung transplantation is used.
  • Pulmonary function as measured by the amount of air in the lungs and the rate and amount of air moving in and out of the lungs with each breath, usually improves within 6 months and the improvement may be sustained for at least 5 years.
  • The overall prognosis for people with bronchiectasis depends on how well infection and other complications are prevented or controlled.
  • Because other conditions diminish the effectiveness of prevention and treatment, people with these conditions tend to have a worse prognosis.

Prevention

  • People who smoke can decrease their risk of aatelectasis aftersurgery by stopping smoking 6 to 8 weeks before an operation.
  • After the operation, everyone should be encouraged to breathe deeply, cough regularly, and move about as soon as possible.
  • The use of breathing devices to encourage voluntary deep breathing(incentive spirometry) and certain exercises, including changing position to increase the drainage of lung secretions, may help to prevent atelectasis.
  • People with chest deformities or neurologic conditions that cause shallow breathing for long periods may benefit from mechanical devices that assist their breathing.
  • One method is continuous airway pressure, which delivers oxygen through a nose or face mask to help ensure that the airways do not collapse, even at the end of a breath.
  • Sometimes additional respiratory support is needed with a mechanical ventilator.
  • Early identification and treatment of conditions that tend to cause bronchiectasis may prevent the development of bronchiectasis or reduce its severity.
  • More than half the cases of bronchiectasis in children can be accurately diagnosed and promptly treated.
  • Childhood immunization against measles and whooping cough, appropriate use of antibiotics and improved living conditions and nutrition have significantly reduced the number of people who develop bronchiectasis.
  • Annual influenza vaccines, use of pneumococcal vaccines and use of appropriate drugs early in the course of infections (such as pneumonia and tuberculosis) helps to prevent bronchiectasis or reduce its severity.
  • Receiving immunoglobulin for an immunoglobulin deficiency syndrome may prevent recurring infections.
  • In people who have allergic bronchopulmonary aspergillosis, the appropriate use of corticosteroids and perhaps the antifungal drug itraconazole may reduce the bronchial damage that results in bronchiectasis.
  • Avoiding toxic fumes, gases, smoke and injurious dusts also helps prevent bronchiectasis or reduce its severity.
  • Inhalation of foreign objects into the airways by children may be prevented by carefully watching what they put in their mouth.
  • Additionally, avoiding oversedation from drugs or alcohol and seeking medical care for neurologic symptoms (such as impaired consciousness) or gastrointestinal symptoms (such as difficulty in swallowing and regurgitation or coughing after eating) may help to prevent aspiration.
  • Also, drops of mineral oil or other oils should never be placed in the mouth or nose because they can be inhaled into the lungs.

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By |2018-07-30T10:12:11+00:00July 30th, 2018|Disease/pathological condition|0 Comments

About the Author:

B. Pharm (K.L.E. society's S.V.V. Patil College of Pharmacy, Bengaluru) M. Pharm (Maharishi Arvind Institute of Pharmacy, Jaipur)

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