Bronchiectasis

Introduction

When you breathe in, air is drawn through your nostrils into your lungs through your trachea which then branches off into two smaller tubes called bronchi. Each bronchus conducts air into one of your lungs where it then divides into smaller tubes also called bronchi. These then branch off into fine tubes called bronchioles that terminate in sacs called alveoli which is where gaseous exchange occurs. There are several forms of respiratory disorders that can interfere with this process. One such disorder affects the bronchi and it is known as bronchiectasis.

What Is Bronchiectasis?

Bronchiectasis is a chronic disorder that arises when the bronchi of the lungs become abnormally widened and thickened, resulting in the accumulation of mucus. As a consequence of this, the airways can become blocked. Since the natural mucus secretion cannot be drained away as it should, it accumulates and provides the ideal environment for microbes to flourish in, giving rise to infections. These factors are responsible for symptoms such as coughing and shortness of breath. This condition may affect one of the bronchi or several. This generally occurs because of damage to the bronchi themselves or to the tissues supporting them.

What Factors Are Responsible For This Condition?

In as many as a quarter to nearly one-half of all diagnosed cases, there is no clearly identifiable cause for this condition. Such cases are referred to as idiopathic in nature. In other instances, there is a range of scenarios and contributing factors that can give rise to bronchiectasis. These are discussed below in brief.

• Often, this condition develops as a consequence of chronic systemic disorders such as cystic fibrosis. In fact, CF is one of the primary contributing factors. This also includes chronic inflammatory disorders such as Crohn’s disease and ulcerative colitis.
• Alternatively, it could also occur as a result of infectious respiratory illnesses that could potentially damage the bronchi in your lungs. This is particularly true of illnesses suffered in childhood. Some examples include pneumonia, tuberculosis, and whooping cough.
• Autoimmune disorders such as systemic lupus erythematosus, Sjogren’s syndrome and rheumatoid arthritis.
• Chronic allergies and the resultant inflammation can also permanently damage the bronchi. Examples of such conditions include asthma and allergic bronchopulmonary aspergillosis.
• Other respiratory disorders such as chronic obstructive pulmonary disease.
• Heritable connective tissue disorders such as Marfan syndrome and Ehlers-Danlos syndrome.
• Long-term exposure to toxic substances such as tobacco smoke or other chemical irritants such as industrial fumes.
• Primary ciliary dyskinesia and Young’s syndrome, conditions which cause defects in the cilia or small hair-like structures lining the respiratory tract as a result of which mucus secretions accumulate.
• Yet another possibility is having a weak immunity which raises the probability of developing infections that could damage the bronchi. This could include HIV infection, undergoing radiation therapy or chemotherapy or taking immunosuppressant drugs for receiving an organ transplant.

What Are The Manifestations Of Bronchiectasis?

Anyone could develop bronchiectasis. Generally, though, symptoms tend to manifest around middle age. The severity of symptoms varies from time to time. Typically, patients suffering from bronchiectasis tend to experience periods when their symptoms worsen. These episodes are called ‘exacerbations’.  This condition is a progressive one since damage to the bronchi is permanent and irreversible.

A detailed list of possible symptoms appears below:

• Shortness of breath.
• Coughing up greenish or yellowish phlegm.
• Blood-tinged phlegm.
• Wheezing.
• Chest pain.
• Weakness.
• The fingertips and nails become distorted and take on a ‘clubbed’ appearance.
  

Are There Different Types Of Bronchiectasis?

Yes. There are two main variants of bronchiectasis. ‘CF Bronchiectasis’ is that which is connected with cystic fibrosis. In all other instances, this condition is labeled as ‘non-CF Bronchiectasis’.  

What Are The Complications?

The most common complication of bronchiectasis is a lung infection. The presence of accumulated mucus in the bronchi increases the probability of infection developing in the lungs. The patient may also develop pleurisy which is inflammation of the pleural membranes. Infections and pleurisy can, in themselves, give rise to a range of complications such as pleural effusion, lung abscesses, and empyema. These can be painful and can severely interfere with the patient’s breathing, which can have fatal consequences.

Another possible critical outcome is the bursting of a blood vessel as a result of the strain on the lungs. This causes the patient to cough up large quantities of blood. This condition should be treated as a medical emergency as there could be a critical loss of blood and the leaking blood could even obstruct the airways even further.

What Tests Are Needed To Diagnose Bronchiectasis?

If you have frequent lung infections and a persistent cough along with phlegm, it is likely that you might be suffering from bronchiectasis. When you visit your doctor for a diagnosis, he or she will most probably carry out the following tests:

• Physical examination and medical history. Upon auscultation with a stethoscope, the patient’s lungs may be heard producing a crackling sound.
• Blood tests.
• A sample of your sputum will be analyzed.
• Chest X-rays.
• Computerised tomography (CT scans) of the chest.

Is It Curable? What Treatments Are Available?

The damage, distortion, and scarring sustained by the bronchi of a person suffering from bronchiectasis is permanent and cannot be rectified. However, there are certain steps that can be taken to manage the condition, ease the symptoms, and prevent them from worsening any further. Certain lifestyle modifications can aid in this process. This would involve cessation of unhealthy habits such as smoking that tends to worsen respiratory symptoms. Patients should also pay attention to diet and exercise.

Most importantly, patients must take care to avoid infections. This will entail taking the necessary vaccines and making sure they are up to date. Those with existing infections are treated with antibiotics. Bronchodilators and special breathing techniques help to ease breathing and prevent breathlessness and resultant symptoms. Certain medical devices can also help to clear away the mucus accumulated in the airways in order to obtain relief.

In instances where the damage is restricted to a small portion of lung tissue, this can be removed surgically by means of a procedure called lobectomy. However, this treatment is not preferred in cases of the extensive disease. Your doctor will advise you on the most suitable course for your condition, bearing in mind parameters such as your age and general health.

Prevention is mainly by addressing the lung conditions promptly and by improving the immune system of the body.

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