Bronchiectasis is a lung disease where the bronchi become enlarged, scarred, blocked, and accumulate secretions due to inflammation. This puts the patient at risk for chronic infections. Bronchiectasis can occur at any age. However, it most often strikes adults.
Definition & Facts
Bronchiectasis can be congenital or acquired. If it’s congenital, it means that the person was born with it because something went wrong with the development of their lungs while in utero. If it is acquired, it means that something caused it after they were born. As of 2016, bronchiectasis is not curable but treatable.
Bronchiectasis can affect an entire lung or part of the lung, though when it affects only part of the lung it is most often caused by a blockage. The damage done to the bronchial tubes causes patients to suffer from episodes of breathlessness and other symptoms called exacerbations. Each exacerbation makes the bronchiectasis worse and often leads to a decline in the person’s overall health.
Without treatment, bronchiectasis can lead to repeated bouts of pneumonia, chronic obstructive pulmonary disease (COPD), and the destruction of the lung tissue. It can also lead to atelectasis, which is the collapse of all or part of the patient’s lung, heart failure and respiratory failure in which not enough oxygen is circulating through the blood. With heart failure, the heart is too weak or damaged to pump enough blood to support the functioning of the body.
Symptoms & Complaints
- Chronic cough
- Thickened skin beneath the toe and fingernails, or clubbing
- Wheezing or other abnormal lung sounds
- Shortness of breath
- Chest pain
- Coughing up blood
- Bad breath
- Coughing up great volumes of mucus
- Frequent bouts of fatigue
- Unexplained weight loss
- Repeated lung infections
Bronchiectasis is most often caused by a lung infection. This infection can occur when the patient inhales food or gastric acid or other foreign objects enter their lungs. It can be caused by gastroesophageal reflux disease (GERD). A person with a weakened immune system, like an HIV patient, is also more at risk for developing bronchiectasis.
Primary ciliary dyskinesia, or PCD is another cause of bronchiectasis. PCD is an uncommon, inherited condition that causes the cilia, or tiny hairs found in the airways to malfunction. Normally, cilia move mucus that has trapped pathogens and debris toward the mouth so it can be expelled from the body. In PCD, the cilia do not perform this function normally.
Doctors have found that cystic fibrosis causes at least a third of bronchiectasis cases. Cystic fibrosis is an inherited disease where the mucus-producing glands throughout the body, especially in the lungs, do not function the way they should. This mucus causes obstruction in the lungs and can lead to chronic infections.
Diagnosis & Tests
A doctor who suspects that their patient has bronchiectasis listens to their lungs through a stethoscope to pick up any abnormal sounds that can indicate that the bronchial passages are blocked. If bronchiectasis is suspected, the doctor orders a sputum test to check for the presence of bacteria; an X-ray or computed tomography (CT) scan of the chest to give a better picture of the lungs; and pulmonary function tests. These tests check how the lungs inhale, exhale, remove carbon dioxide from the blood, and add oxygen into the blood.
The doctor may also give the patient a purified protein derivative skin test or PPD to check for tuberculosis. Bronchiectasis is not contagious unless it appears with tuberculosis. If other tests do not provide a clear diagnosis, the doctor may give the patient a bronchoscopy. This is where a flexible tube with a light and camera at the end is inserted into the patient’s nose or mouth and into the bronchial tubes. The doctor studies the images that are projected onto a video monitor to see if there’s a blockage, bleeding, or other types of damage in the lungs.
Treatment & Therapy
Bronchiectasis can be successfully treated and patients can live full lives if they are treated promptly after symptoms appear. A doctor can prescribe antibiotics and bronchodilators. Bronchodilators, which include drugs like albuterol, enable the bronchi to open up and allow more air to flow in and out of the lungs.
Doctors also prescribe medications like acetylcysteine to thin the mucus and expectorants that help the patient cough the mucus up. Oxygen therapy is also available to bronchiectasis patients who are in danger of respiratory failure.
Some patients are fitted with a chest wall oscillation vest. These vests compress and release the chest, which helps the body get rid of excess mucus. It acts much like a cough but does not require exertion on the part of the patient.
The doctor can recommend a respiratory therapist who can teach the patient how to safely and effectively cough up the mucus in their airways or perform chest physical therapy on the patient. This involves thumping the patient on the chest and back to help them dislodge the mucus in their lungs.
The doctor will also tell the patient that they need to stay hydrated and drink plenty of water. Water loosens the thick mucus that clogs the airways. If an area in the patient’s lung is bleeding, the doctor may perform surgery to remove it. Secretions in the bronchi may also need daily draining. If the bronchiectasis is comorbid with another disease such as HIV or COPD, these conditions will be treated at the same time.
Prevention & Prophylaxis
Children should be vaccinated to prevent lung infections that can lead to them developing bronchiectasis when they grow up. Formerly common childhood diseases such as whooping cough and measles used to put many children at risk of bronchiectasis when they became adults.