bronchiectasis

Bronchiectasis

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

  • Bronchiectasis can result from several conditions that injure the bronchial wall directly or indirectly by interfering with its normal defenses against potentially harmful substances.
  • The most common cause is sever respiratory infections.
  • Immune deficiency disorders, hereditary disorders such as cystic fibrosis (a disorder in which abnormal mucus impairs the ability of cilia to clear the bronchi of the organisms that cause infections) and mechanical factors such as bronchial obstruction (caused by an inhaled object, a lung tumor or other disorders) may predispose a person to infections that lead to bronchiectasis.
  • A small number of cases probably result from inhaling toxic substances that injure the bronchi, such as noxious fumes, gases, smoke (including tobacco smoke) and injurious dust (silica and coal dust).
  • In bronchiectasis areas of the bronchial wall are destroyed and become chronically inflamed, ciliated cells are damaged or destroyed and secretions or mucus accumulate.
  • Also, the bronchial wall becomes less elastic. The affected airways become wider and flabby and may develop outpouchings or sacs that may resemble tiny balloons.
  • The increased mucus production promotes the growth of bacteria, often obstructs the bronchi, and leads to the pooling of infected secretions and further damage to the bronchial wall.
  • The inflammation and infection can extend to small air sacs of the lungs (alveoli) and produce pneumonia, scarring and a loss of functioning lung tissue.
  • In severe cases, scarring and a loss of blood vessels in the lungs can ultimately strain the right side of the heartas the heart rises to pump blood through the altered vessels.
  • Also, inflammation and an increased number of blood vessels in the bronchial wall (which are fragile) can result in a person coughing up blood.
  • Blockage of the damaged airways can lead to abnormally low levels of oxygen in the blood.
  • Bronchiectasis may affect many areas of the lung or it may appear in only one or two areas.
  • Typically, bronchiectasis causes the widening of medium-sized bronchi, but often smaller bronchi becomes scarred and destroyed.
  • Occasionally, a form of bronchiectasis affecting larger bronchi occurs in allergic bronchopulmonary aspergillosis, a condition caused by an allergic response to Aspergillus fungus.

Symptoms

  • 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.

Selected causes of Bronchiectasis

  • 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)

Diagnosis

  • 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.

Prevention

  • 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.

Treatment and Prognosis

  • 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.

Bronchiectasis life expectancy

  • In mild bronchiectasis there is no shortage of life expectancy.
  • In very severe bronchiectasis, however, some patients die at a younger age because of their lung disease.

Click here to go to lung disorders forums.

Wikipedia

By |2018-07-24T13:30:39+00:00July 17th, 2018|Disease/pathological condition|1 Comment

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)

One Comment

  1. Design Reply July 20, 2018 at 9:32 am - Reply

    Thanks for this Huge post. I really Delight In reading and I have been affected because as a matter of fact your content is very Important

Leave A Comment

WE NEED YOUR HELP IN CREATING AWARENESS ABOUT DISEASES AND MEDICINES

In today's fast paced life, we often come across minor health issues that we often neglect due to lack of time for paying a visit to a doctor, which usually takes away 2-3 hours of a person's time and are expensive too. Further more, such minor conditions may grow big at any time if neglected. Our aim in setting up this platform is that any person can search for any health condition or medicines and can get all the needed information within hardly 10-15 minutes, which saves a lot of time and money. After going through every information, if the person has any questions, he/she can go to our forums section and raise a topic. This will help him/her decide better whether he/she needs to pay an immediate visit to a doctor or can it wait for a day or two? Help us in bringing awareness about diseases and medicines by spreading the word to at least 5 of your friends and relatives.