A B C D E F G H I J K L M N O P R S T U V W

BRONCHIECTASIS

What is Bronchiectasis ?

The lungs are made up of a series of branching tubes, which carry air from the main windpipe (trachea) to the lung tissues, where oxygen gets absorbed into the bloodstream. The term bronchiectasis comes from two Greek words: bronchion meaning windpipe, and ektasis meaning stretching out. So, literally, bronchiectasis is a condition in which the tubes (bronchi) of the lungs are opened out too wide. This abnormal state is permanent, and causes the symptoms of cough and shortness of breath. The cough is very persistent, usually with large amounts of thick, often yellow, phlegm. Coughing up of blood is not uncommon. Sometimes bronchiectasis affects the bronchi in only one or two parts (segments or lobes) of the lungs generally the lower lobes. It is not a common condition, affecting less than 1% of the adult population.

How does Bronchiectasis occur ?

Somehow, in a way that is not completely understood, damage to the lining of the bronchi occurs. This sets up a type of inflammation which in the long-term stretches and widens the bronchi. There is a chemical or enzyme called elastase, which gets released in increased amounts by the inflammation, and destroys normal tissue. Sometimes the natural defences of the lining (which include tiny hairs on the surface to waft away the germs and foreign particles) are defective. This is rare, and tends to run in families. Usually it is a lung infection, which sets up the inflammation.

Why does Bronchiectasis occur ?

Usually an attack of pneumonia, or a severe lung infection in childhood, particularly with measles or whooping cough, is responsible for the initial lung damage. For the rare causes, which are inherited, such as cystic fibrosis, there is some fault in the normal defences of the lung, which makes the person prone to lung damage.

Treatment Involved for Bronchiectasis

The main feature of the condition is the production of large amounts of mucus, which leads to a very fruity (productive) cough. The main aims of treatment are to clear this sputum as much as possible, and to minimize infection. This is achieved by physiotherapy and antibiotic treatment. Physiotherapy concentrates on postural drainage. This involves the patient being positioned in such a way as to help the sputum drain away from the part of the lung which is affected. Other physiotherapy techniques include auto-drainage, and forced expiratory technique. Antibiotics are not given continuously, but as frequent short courses when the sputum becomes thick and discoloured (purulent). Occasionally, different antibiotics may be given in rotation, with a short break between courses. This is to prevent the germs that infect the sputum becoming resistant to the antibiotics. Other drugs (bronchodilators and steroids) may be helpful in cases where bronchospasm (narrowing of the bronchi in other areas of the lung) occurs. It is extremely unusual for doctors to operate for bronchiectasis. Surgery is usually offered to those patients who have not responded to medical treatment with drugs and physiotherapy. It may be offered if the disease is confined to one area of one lung and is causing a lot of symptoms. Nobody who has bronchiectasis should smoke as this worsens the condition.

During Treatment of Bronchiectasis

Complications are uncommon, but pneumothorax (collapsed lung) and lung abscess can occur. Regular review by the doctor will be necessary. If symptoms get worse breathing tests may need to be carried out by a chest specialist. A CT (computerised tomography) scan is the best test for diagnosing bronchiectasis. This enables your doctor to get a clearer picture of the parts of the lung, which have been affected. Another test using a special X-ray called a bronchogram, is used infrequently.

After Treatment of Bronchiectasis

Generally speaking, symptoms improve after treatment, and regular review, combined with breathing exercises and general health measures will control the condition well, giving good long-term prospects. Any worsening of symptoms or the coughing up of blood should be notified to the doctor.

If Bronchiectasis is Left Untreated

It is very important that bronchiectasis is treated vigorously once it has been discovered. Without treatment inflammation and infection in the damaged bronchi will continue. This leads to a steady worsening in the function of the lungs, and more cough and breathlessness. More serious complications of infection are very uncommon, but can occur, and include bleeding from the lungs.

Effects on Family of Bronchiectasis

Relatives or friends are often very helpful in carrying out physiotherapy once they have been taught how to do so. As well as offering general support and encouragement, they can ensure a cigarette smoke-free environment at home. Passive smoking can be as harmful as the real thing!