Bronchiectasis is a lung disease, which is characterized by the permanent damage and widening of one or more of the large connecting bronchi (airways). Infections cause a change in the muscular and elastic components of the bronchial wall, which then become distorted and enlarged. This enlargement can be uniform or irregular. It begins a cycle in which the airways slowly lose their ability to clear mucus. As the mucus builds up, serious lung infections can then occur, which can cause more damage to the bronchi. This results in the vicious cycle of bronchial damage, bronchial dilation, inability to clear secretions, reoccurring infection and more bronchial damage. Over time, the airways become chronically inflamed, more stretched out, scarred and easily collapsed, resulting in airflow obstruction. In advanced cases, this can affect how much oxygen reaches the body's organs, leading to other serious illnesses involving damage to those critical organs.
There are two basic types of bronchiectasis:
Congenital bronchiectasis is present at birth, usually only affects infants and children, and is the result of developmental arrest of the bronchial tree in the fetus.
Acquired bronchiectasis occurs in adults and older children and is the more common form. Some of the more common causes are:
Chronic long diseases such as:
Note: CF is considered the major lung disease contributing up to 50% of bronchiectasis cases
Young Syndrome, a disease very similar to CF and may be a genetic variant
Kartagener's Syndrome, a rare inherited disease that combines the loss of ability to clear mucus and chronic sinusitis
Severe lung infections such as repeated episodes of pneumonia, fungal infections, whooping cough, and other
disorders that affect the cilia (the small hair like structures that line the airways and help clear out mucus
Immunodeficiency disorders such as HIV
Blockages of the airways
Growths and tumors
Inhaled substances (a peanut, a small toy, etc.)
Impaired ability to swallow, causing food or saliva to enter the lungs
Severe heartburn (gastroesophageal reflux disease) (GERD) allowing stomach contents to enter the lungs
Drug abuse (especially heroin)
In a small number of case, inhaling toxic substances that injure the bronchi, such as noxious fumes, gases, smoke
(including tobacco smoke), and injurious dust (silica, coal dust, glass dust) can lead to bronchiectasis. Chlorine gas,
sulfur dioxide and ammonia are among the more suspected noxious fume agents.
NOTE: There have been some reports that some service personnel who have seen duty in Iraq were exposed
to large concentrations of ammonia and have developed bronchiectasis.
The symptoms for bronchiectasis fall into two broad categories.
The most common symptoms in early stages of bronchiectasis are:
Daily cough, over months or years
Daily production of large amounts of mucus, or phlegm (flem)
Repeated lung infections
Shortness of breath
The more serious longer term symptoms and conditions occurring in more advanced stages of bronchiectasis in addition to the above may include:
Coughing up blood or bloody mucus
Coughing that worsened by lying on one side
Clubbing of fingers
Change in skin color
Bluish indicating oxygen deficiency
This involves a series of tests designed to identify underlying causes of any symptoms and to determine the amount of damage to the lungs. Since the symptoms for bronchiectasis are very similar to other conditions such as chronic asthma and chronic bronchitis, a major part of the diagnosis involves eliminating the possible other conditions. The most common tests are:
Chest X-ray, which can show infections and scarring
CT Scan, considered a defining test for bronchiectasis, can show how much damage is done to the airways as
well as the exact location of the damage
Pulmonary Function Tests (PFT), including:
Lung volume measurements
Diffusion capacity (DLCO) which measure how well the lungs take in and exhale air, and how efficiently
they transfer oxygen
Complete blood count (CBC)
Arterial Blood Gas (ABG)
Sputum cultures can show if you have bacteria, fungi, or tuberculosis
Sweat tests (A patch test for Cystic Fibrosis)
A bronchoscope is a long narrow, flexible tube with a light on the end which is inserted through your nose or
mouth into your airways, and provides a video image of the airways. It also allows your doctor to see possible
blockages as well as collecting samples of mucus.
There are three classifications of bronchiectasis which describe the severity of the condition:
Cylindrical - most common and refers to the slight widening of the respiratory passages. This type can be reversed
and may be seen after acute bronchitis
Varicose - bronchial walls have both extended and collapsed portions
Cystic - most severe and involves irreversible ballooning of the bronchi
Treating and managing
Early diagnosis and treatment plans are designed primarily to slow the progression of the disease, and to prevent additional damage to the lungs.
Treatment plans encompass several categories
Treatment of underlying conditions
Treatment of respiratory infections early and aggressively
Prevention of future complications
In advanced instances
Surgery to remove portions of the lungs.
Single and double lung transplant
The prognosis for people with bronchiectasis is quite varied and dependent on a number of factors, including:
How early a comprehensive treatment plan was implemented
How well subsequent infections are controlled
The prevention of relapses is critical to a patients longevity. Relapses of bronchiectasis can be controlled with
antibiotics, chest physiotherapy, inhaled bronchodilators, proper hydration, and good nutrition.
The effects of other systemic diseases which impact the effectiveness of treatments Among the more common
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