Bronchiectasis is a condition of the lungs where the airways (windpipes) become widened and enlarged so that lung secretions and mucus do not pass out of the airways normally and instead can pool in the lung leading to infection. This can lead to cough, recurrent bronchitis, recurrent pneumonia, and production of large volumes of sputum.
There are a large number of diseases which can cause bronchiectasis and your physician may recommend tests to look for some of these underlying diseases. Cystic fibrosis is a common cause of bronchiectasis in children and lung adults, however, cystic fibrosis occasionally is not diagnosed until adulthood or even on occasion middle age. Immunodeficiencies (low levels of antibodies in the blood) can cause bronchiectasis due to recurrent infection due to low antibody levels. Previous bouts of severe pneumonia or tuberculosis can cause bronchiectasis. Certain unusual diseases like allergic bronchopulmonary aspergillosis, a cause of severe asthma, can cause bronchiectasis in its later stages. Longstanding gastroesophageal reflux (see Web file on gastroesophageal reflux) can cause mild bronchiectasis. Abnormalities in the cilia (hair like projections on the lung lining cells) can cause bronchiectasis, sometimes in conjunction with infertility. Alpha-1 antitrypsin deficiency is a cause of emphysema that can sometimes cause bronchiectasis instead. Sometimes, the cause of bronchiectasis cannot be determined.
The most common symptoms of bronchiectasis are cough with sputum production. Although cough without sputum can occur in some patients with bronchiectasis, most patients produce large quantities (up to a quarter cup or more of sputum per day). Patients often get repeated infections and will be diagnosed with frequent bronchitis and/or frequent pneumonias. The diagnosis can sometimes be suspected by the physician if he/she hears abnormal crackling sounds when listening to the lungs.
Bronchiectasis is often diagnosed by a high resolution chest CT scan which your doctor may order to determine if bronchiectasis is present. In the past, bronchograms were done to diagnose bronchiectasis but these are rarely done anymore since CAT scans are much easier and safer.
Once diagnosed with bronchiectasis, there are certain things that you can do which will reduce the frequency of infections. By reducing the frequency of infections, you can slow the progression of the bronchiectasis or even keep it stable. Reducing the frequency of infections is a major goal in the treatment of bronchiectasis. A Pneumovax (pneumonia vaccine) is usually given every six years to prevent common forms of pneumonia and bronchitis. An influenza vaccine (flu shot) is given every fall to prevent influenza which frequently turns into pneumonia in patients with bronchiectasis. Most patients are frequently given antibiotics when their sputum increases in volume, their cough increases, or their sputum becomes colored (yellow, green, or gray).
A major goal in treating bronchiectasis is to bring up the sputum so that it does not pool in the lungs and become infected. There are several things you can do to help raise the sputum and get it out of the lungs. Percussion and postural drainage is performed by tapping or slapping the back to help loose secretions and can be taught by a respiratory therapist to family members or friends. A flutter valve is a small device which has a ball bearing which vibrates when you blow out causing the air within your windpipes to vibrate and therefore loosen secretions. This is a very good option for patients who are unable to perform percussion and postural drainage or even as an addition to percussion and postural drainage. Flutter valves can be obtained by prescription from your local pharmacy, from TheraCom (800-515-8873), or from Nelcor-Puritan Bennett Company (800-826-2069). When the lungs become infected, outpatient treatment with oral antibiotics is often sufficient. However, for severe cases or for infections by difficult to treat bacteria, (such as Staph, or Pseudomonas), treatment with intravenous antibiotics is often required. This no longer requires the patient to be in the hospital as intravenous antibiotics can be given in the home by a visiting nurse in most cases.
Because most patients with bronchiectasis will have some bronchospasm, bronchodilators (such as Atrovent, or albuterol) can be very useful. Some patients will further require treatment with steroids (either oral corticosteroids or inhaled steroids) to further reduce inflammation of the airways.
Although bronchiectasis is a permanent condition, with proper preventive care, most patients can enjoy a high quality of life with minimal impairment by the underlying bronchiectasis.
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