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Bronchiectasis

Bronchiectasis is defined as a chronic dilation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction. Air is carried in and out of the lungs by branching air passages. Normally these air passages (the medical term is bronchi) taper smoothly towards the periphery of the lung. This injury is the beginning of a cycle in which your airways slowly lose their ability to clear out mucus. The mucus builds up and creates an environment in which bacteria can grow. 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. In bronchiectasis because of the inability to clear secretions effectively, these secretions become infected. As a result of this infection the airways produce more secretions which in turn become infected. Also, inflammation and an increased number of blood vessels in the bronchial wall (which are fragile) can result in a person coughing up blood. Typically bronchiectasis causes widening of medium-sized bronchi, but often smaller bronchi become scarred and destroyed.

Bronchiectasis is an abnormal destruction and dilation (widening) of the large airways. The disease, left untreated will continue to damage lung tissue and bronchial tubes and cause emphysema and severe breathing difficulties. This can affect how much oxygen reaches your body organs. If your lungs cannot move enough oxygen into your body, bronchiectasis can lead to serious illness, including heart failure . A small number of cases probably result from inhaling toxic substances that injure the bronchi, such as noxious fumes, gases, smoke (including tobacco smoke), and injurious dust (silica, coal dust). The mucus is difficult to clear because of the damage to the normal ways the airways clear the mucus. This can lead to episodes of infection and then, worsening bronchiectasis. Early diagnosis and treatment of bronchiectasis and the infections that occur are very important.

Causes of Bronchiectasis

The common Causes of Bronchiectasis :

• Cystic fibrosis.
• Something blocking off part the airways, for example, a piece of food stuck in the airway.
• Infections that damage the airways (pneumonia, tuberculosis, etc.) .
• Immunodeficiency disorders, such as HIV infection and AIDS.
• Allergic bronchopulmonary aspergillosis, an allergic reaction to a fungus called aspergillus that causes swelling in the airways.
• Mechanical obstruction of the bronchial tubes by inhaled foreign bodies, for example, peanuts .
• Inhaling stomach acid which has been regurgitated back into the gullet
• Tuberculosis (TB) and other similar infections.
• Diseases that affects the tiny hairs (cilia) inside the airways, for example Primary Ciliary Dyskenesia, Kartenager's Syndrome, etc.

Symptoms of Bronchiectasis

Some Symptoms of Bronchiectasis :

• Skin discoloration bluish .
• Fatigue.
• Morning cough
• Breath odor.
• Shortness of breath
• Weight loss.
• Chest pain
• Wheezing.
• Coughing up blood .
• Paleness .
• Breathlessness.
• Clubbing.
• Anemia.

Treatment of Bronchiectasis

• Antibiotics should be prescribed on the basis of sputum culture and sensitivity testing. Prophylactic antibiotics and vaccination should be considered in patients who persistently produce purulent sputum.
• Bronchodilators may help in patients with asthma , ABPA or cystic fibrosis.
• Treatment of nose and runny nose using nasal drops and sprays.
• Smoking makes symptoms worse and smokers are very strongly advised to stop.
• If you are able a daily exercise such as running, walking, swimming, dancing, aerobics, etc, helps to clear the mucus too.
• Surgery may be considered to control localised disease or severe haemoptysis.
• Inhaled or oral corticosteroids may slow disease progression and are particularly useful for the treatment of ABPA.
• Basic measures such as regular postural drainage and chest physiotherapy can help to clear sputum and provide symptomatic relief.
• Treatment of bronchiectasis is aimed at controlling bronchial secretions, and relieving airway obstruction.

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