Bronchiectasis
Bronchiectasis is a chronic lung condition characterized by the permanent dilation and damage of the bronchial tubes, which can lead to serious respiratory complications. This condition often arises from prior lung infections like pneumonia or tuberculosis, but can also result from congenital issues or environmental factors such as exposure to toxic substances. Individuals with bronchiectasis may experience chronic coughing, excessive mucus production, wheezing, and shortness of breath, among other symptoms. The accumulation of thickened mucus can trap bacteria, increasing susceptibility to recurrent lung infections and further lung damage.
Although bronchiectasis cannot be cured, it can be managed with medications that help clear mucus and control infections. Preventative measures, including vaccinations and lifestyle changes, are crucial for reducing the risk of exacerbations. Diagnosis involves a thorough medical history, sputum analysis, and imaging tests to assess lung damage. With appropriate treatment and care, many individuals with bronchiectasis can maintain a good quality of life, despite the challenges posed by the condition.
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Bronchiectasis
Bronchiectasis is a rare and chronic lung condition. People affected by this condition have bronchial tubes—which carry air in and out of the lungs—that are damaged, inflamed, and/or have often lost their elasticity. Over time, the walls of the tubes thicken and dilate, meaning the interior diameter widens. This leads to infections and further damage that eventually impairs the ability to breath. While the condition cannot be cured, it can be controlled with medication, and people who have bronchiectasis can have a good quality of life.
Background
René Laënnec, the French doctor who invented the stethoscope, first diagnosed bronchiectasis. He was able to distinguish the condition from several other diseases by the specific breath sounds he heard when listening to the air moving through the bronchial tubes in a patient's lungs.
Bronchial tubes are pathways in the lungs. They are lined with membranes that contain small hairlike projections called cilia surrounded by a coating of mucus, a thick slippery substance that is produced by the body to lubricate and protect some membranes, including the lungs. The cilia move back and forth, pushing the mucus up and out of the lungs. In a person with bronchiectasis, these cilia are destroyed, and the body no longer has a mechanism to remove the mucus. It thickens and becomes phlegm, the substance sometimes expelled when a person coughs hard.
The thickened mucus traps organisms such as bacteria and holds them in the lungs, making an affected person more susceptible to infections. This can lead to increased lung damage and reduce the person's ability to breath. Other health conditions, such as heart disease and respiratory failure, may then result.
Overview
Bronchiectasis is a chronic, ongoing health condition. It usually comes on over time after some form of illness or injury causes damage to the bronchial tubes. These cases are considered to be acquired. In some cases, a child is born with lung damage that leads to bronchiectasis. In these instances, bronchiectasis is considered congenital because it was in place at birth.
Some of the most common causes of this damage include contracting illnesses such as pneumonia, whooping cough, tuberculosis, or other diseases that affect the lungs. Other causes of bronchiectasis may include chronic drug or alcohol abuse and exposure to substances that cause lung damage, such as toxic gases. People who have other diseases that compromise the immune system and people who have an allergic condition known as allergic bronchopulmonary aspergillosis (ABPA), a condition in which a reaction to a specific type of fungi irritates the lungs, can also acquire bronchiectasis. Cystic fibrosis and alpha-1 antitrypsin deficiency can lead to bronchiectasis as well. Occasionally, bronchiectasis is present in just one lung. These cases are usually caused by some sort of obstruction or blockage in that lung.
In some instances, the cause of the condition cannot be determined. This is because it can take years for symptoms of bronchiectasis to develop, obscuring the initial cause. In the past, many cases were diagnosed in childhood. Due to efforts to curb whooping cough and other childhood illnesses, fewer children develop the condition, and most modern cases are diagnosed in adults.
A person with bronchiectasis will have symptoms such as chronic coughing and may cough up blood or large amounts of mucus. Breathing will often be accompanied by wheezing or other unusual sounds. Chest pains and shortness of breath may be present, and the person may have halitosis (bad breath). As the condition limits the amount of oxygen the body takes in, the person may exhibit other signs of illness including fatigue, weight loss, a bluish tinge to the skin, and a thickening of the skin under finger and toenails.
A physician will diagnosis bronchiectasis by taking a complete medical history. The sputum, or expelled mucus, will be analyzed, and a chest X-ray and/or computerized axial tomography (CAT) scan will be done to determine if there is lung damage. Additional tests may be ordered to try to pinpoint the underlying cause of the condition, especially if cystic fibrosis or an aspergillosis infection is suspected, as these conditions require additional treatment. Breathing tests will also be ordered to determine how much the disease has progressed.
The condition is treated with medications that loosen mucus secretions and with other medications, such as corticosteroids, that help regulate the bronchial passages. This helps prevent further infections that can worsen the bronchiectasis. Other measures to prevent infections will also be recommended, including immunizing against whooping cough and pneumonia, eating a healthy diet, and avoiding potential sources of infection. Patients who smoke will be advised to quit, and all patients will warned to avoid areas where cigarette smoke may be present.
Patients may also undergo physical therapy, during which the chest is thumped rhythmically to help loosen mucus. Some patients may receive oxygen to reduce the effects of the condition. Patients who contract an infection or who have a blockage or other obstruction in the lungs may require hospitalization for treatment with antibiotics and may need surgery.
Some of the risk factors for bronchiectasis are avoidable while others are not. Congenital conditions such as alpha-1 antitrypsin deficiency and illnesses such as cystic fibrosis are unavoidable. However, the risk of pneumonia, whooping cough, and other diseases that have the potential to cause lung damage can be minimized by vaccinating, eating a healthy diet, and practicing proper hygiene. Drug and alcohol abuse, smoking, and exposure to toxic chemicals also increase the risk of acquiring bronchiectasis.
Bibliography
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