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Bronchiectasis is a chronic inflammatory or degenerative condition of one or more bronchi or bronchioles of the lungs marked by dilatation and loss of elasticity of the walls. Infection is the mechanism by which the disease progresses. The disease, left untreated, will continue to damage lung tissue and bronchial tubes and cause emphysema and severe breathing difficulties.
Dilation of the bronchial walls results in airflow obstruction and impaired clearance of secretions because the dilated areas interrupt normal air pressure of the bronchial tubes, causing sputum to pool inside the dilated areas instead of being pushed upward. The pooled sputum provides an environment conducive to the growth of infectious pathogens, and these areas of the lungs are thus very vulnerable to infection. The more the lungs experience infections, the more lung tissue and alveoli are damaged, and the more inelastic and dilated the bronchial tubes become, perpetuating the cycle of the disease.
Bronchiectasis was first described by René Laënnec in 1819 and later detailed by Sir William Osler in the late 1800s.
Diagnosis
The diagnosis of bronchiectasis is based on a clinical history of daily viscous sputum production and characteristic CT scan findings (such as multiple cysts near the bottom of the lung). A "Tree in bud" pattern may be seen on CT scans. However, bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent lung infections, a trademark symptom of bronchiectasis.
Early diagnosis of bronchiectasis is critical in slowing or stopping the disease's progression while the disease is still manageable. Bronchiectasis is more common among the populace than people may realize. Often, the disease in its early stages is dismissed as bronchitis or asthma, but if a person gets frequent lung infections, there is a very good chance he or she could have bronchiectasis, and he or she should take care to prevent further infections.
Treatment
Treatment of bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. This includes fighting infections with antibiotics and eliminating the fluid with postural drainage and chest physiotherapy.
A classic bacterium that is seen in people with bronchiectasis is Pseudomonas aeruginosa, which is notoriously hard to eradicate. Repeated infections of the airways by this bacterium can lead to colonization of the bronchi by this organism which predisposes such people to Pseudomonal pneumonias, which requires special antibiotics to treat. It is controversial whether to give those with bronchiectasis daily antibiotics to prevent infection from happening or whether to treat each time they become ill.
Causes
The most common cause worldwide is scarring from tuberculosis. In the United States the most common cause is probably cystic fibrosis. Chronic tobacco use (smoking) can also lead to emphysema in 20% of smokers, which can lead to chronic bronchitis (productive cough more than 3 months in 3 consecutive years), which in turn can lead to scarring of the bronchi that develops into bronchiectasis. Adults can have inherited immunodeficiencies that present as recurrent lung infections that ultimately lead to bronchiectasis.
It is characteristic in a number of conditions, particularly Kartagener syndrome.
Prevention
Non-hereditary bronchiectasis often results from initial injury to the lungs, and thus prevention of injury such as pneumonia is critical, especially in children and immunodeficient individuals.
If injury has already occurred, special care should be taken to prevent relapse of infection:
- Vulnerable populations should receive flu and pneumonia shots according to schedule.
- Wear appropriate clothing for varying temperatures to avoid weather-related illness.
- Get regular exercise, and eat and sleep well.
- Avoid overexertion or excess fatigue--timely rest is crucial.
- Use of inhalers such as Albuterol and Flovent may help reduce likelihood of infection by clearing the airways and decreasing inflammation.
- If yellow or green sputum develops, seek medical treatment immediately so that the infection can be mitigated as soon as possible. The longer an infection remains in the lungs, the more damage the lungs incur.
- Avoid breathing smoke or other irritating substances.
External links
Chronic Bronchitis is defined as symptoms for 3 months during 2 years.
Bronchiektasie | Bronquiectasia | Bronkiektasi | Rozstrzenie oskrzeli | Bronkiektasier
"Bronchiectasis"