What is Bronchiectasis
Bronchiectasis is a chronic obstructive pulmonary disease diagnosed by the permanent widening and overall damage of the bronchial tubes.
As air enters the lungs, it passes through several branches known as the bronchi. From there, the air passes into tiny air sacs (alveoli) where the oxygen is swapped for carbon dioxide in the bloodstream. It is crucial for optimum lung performance that the bronchi stay moist, so tiny glands in the lining of the bronchi produce mucus.
Mucus also traps dirt and dust that travel in with the inhaled air. The cilia (tiny hairs) along the surface of the bronchi act like brooms to sweep the mucus (and the dust and dirt and other particles the mucus has collected) to the back of the throat where it is either swallowed or coughed up. This keeps the airways clear.
Over the course of bronchiectasis, the cilia become damaged and are no longer able to sweep the mucus away. As the mucus builds up, the bronchi are stretched and can form little pockets where germs, dust, and mucus can collect and sit. If the germs, dust, and mucus sit there long enough, the airways become infected and, since the cilia are damaged, the infections can return.
As the airways become stretched, they are also unable to complete the oxygen/carbon dioxide swap with the bloodstream, which can affect the health of other organs.
Causes and Symptoms of Bronchiectasis
There are two forms of bronchiectasis. Congenital bronchiectasis is present at birth and usually only affects infants and children. In this case, the bronchial tree has not developed properly.
Acquired bronchiectasis is the most common form and usually affects adults and older children.
There are several risk factors that can make some people more prone to developing bronchiectasis than others. They include (from www.copd-international.com):
- Chronic lung diseases: Cystic Fibrosis (CF accounts for up to 50 per cent of all bronchiectasis cases); Tuberculosis; Allergic Aspergillosis; Young Syndrome (considered a genetic variant of CF); Kartagener's Syndrome; Alpha 1-antritrypsin deficiency
- Severe lung infections and repeated episodes of pneumonia, fungal infections, whooping cough, other disorders that can damage the cilia
- Immunodeficiency disorders
- Blockages of the airways due to growth and tumors, inhaled substances, or mucus plugs
- Impaired ability to swallow, causing food or saliva to enter the lungs
- Gastroesophageal reflux disease (GERD) where stomach contents enter the lungs
- Drug abuse (particularly heroin)
- Inhaling of noxious fumes such as from chlorine gas, sulfur dioxide, and ammonia, inhaling of smoke (including tobacco smoke), and of silica, coal, and glass dust.
As with many conditions and diseases, the onset and severity of symptoms varies from patient to patient. Bronchiectasis can develop at any age, but can often be traced back to childhood.
In the early stages, symptoms include:
- Daily cough over months or years
- Daily production of large amounts of mucus
- Recurring lung infections
- Wheezing, chest pain, bad breath, shortness of breath
As the damage to the lungs increases, patients in more advances stages of the disease will likely display:
- Coughing up blood or mucus with blood in it
- Coughing that worsens by lying on one side
- Clubbing of fingers (flattening of the "v" shape at the base of the nail at the cuticle to the first knuckle)
- Cyanosis (bluish tinge to skin)
- Weight loss
- Fatigue
- Inability to concentrate
- Sinus drainage
- Heart failure
- Brain abscesses
Diagnosis and Treatment of Bronchiectasis
Bronchiectasis can be confirmed through a CT scan of the chest but, additional diagnostic tests will be necessary to determine the underlying reason for the build up of mucus.
Treatment often involves the use of antibiotics to help fend off the infections. Prolonged used of antibiotics, though, presents the possibility that a person may become immune to the effects of the antibiotics or that recurring infections will not be successfully fought off. Physiotherapy (eg: clapping on the chest) and other exercises might be recommended to help your body get rid of the excess mucus (eg: swimming). Some patients may respond to steroid and bronchodilator inhalers, similar to that which is used by asthmatics.
It is highly recommend that those with the above conditions to ensure their immunizations are up-to-date, that they do not smoke, and do not leave underlying conditions untreated.
As mentioned earlier, the damage done to the lungs is irreversible. There is no known cure. It is up to you as a patient or as a caregiver to a person who might be susceptible to bronchiectasis to ensure the proper precautions are taken to avoid infection and keep the lungs working properly.
Sources: www.nhlbi.nih.gov; www.lung.ca (Canadian Lung Association); www.merck.com; www.wrongdiagnosis.com; http://emedicine.medscape.com; www.copd-international.com; www.patient.co.uk