Bronchiectasis

Bronchiectasis

What is bronchiectasis?

Bronchiectasis means abnormally and permanently dilated (or enlarged) airways. This is as a result of irreversible thickening and damage to the walls of the airways. The airways can no longer clear mucus and it accumulates in the lungs, causing frequent bacterial chest infections.

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Bronchiectasis could be caused by inherited or acquired problems. Worldwide, tuberculosis is the commonest cause, while an inherited condition known as cystic fibrosis is the most common cause of bronchiectasis in developed countries. It could also be caused by airway obstruction from foreign bodies and cancers, or inhalational injury from noxious gases or chemicals.

What are the symptoms?

The condition is characterised by coughing up large amounts of discoloured sputum (or mucus). People with mild disease only produce yellowish or greenish sputum after an infection. However, depending on the area of the lung that is affected, and the position of the patient, the cough may be dry instead, or produce blood.

As the condition worsens, one may suffer persistent halitosis (bad breath), repeated fevers with a general feeling of illness. Breathlessness may also occur either from an infection or from airflow limitation.

What treatments work?

Physiotherapy may be used to assist the drainage of excess mucus. A physiotherapist should teach you how to do this. When properly done, this is of great value both in reducing the amount of cough and mucus produced and in preventing repeated infections.  Exercises to strengthen your chest muscles can make it easier to breathe more freely and to live a more normal life. The physiotherapist or your doctor should teach you how to do these exercises using a special device.

When there’s airflow obstruction, the doctor will prescribe inhaled bronchodilators and corticosteroids to open up the airways and decrease the rate of progression.

Mucolytics (drugs to break up mucus) may also be recommended for people who have cystic fibrosis. They are also inhaled.

Salt water (hypertonic saline) may be used to make the mucus thinner. It is converted into inhalable vapour using a special machine.

Antibiotics are used to completely clear chest infections especially in individuals with cystic fibrosis in order to halt the progression of the disease. The doctor will decide the best antibiotics to use depending on the organism causing the infections.

Surgery

Unfortunately, it is rare for the affected parts of the lungs to be sufficiently identified for surgery to be practical. Lung or heart-lung transplantation is sometimes required especially in very serious cases.

What will happen?

The advent of effective antibiotic therapy has greatly improved the outlook of bronchiectasis. Ultimately, most people with severe bronchiectasis will develop respiratory failure or involvement of the heart, but those with mild disease have normal life expectancy.