Bronchiectasis is an excessive and irreversible dilation of the bronchial tree that leads to mucous build up, shortness of breath, coughing and infections, it’s caused by repetitive cycles of bronchial inflammation, mucus plugging and progressive airway obstruction.
Despite that a lot of people are diagnosed idiopathic bronchiectasis but it has two main causes
1- Lung infection and inflammation
2- (A) disorders of inadequate secretion or mucus plugging: Cystic fibrosis, Primary ciliary dyskinesia (PCD), Allergic bronchopulmonary aspergillosis.
(B ) Bronchial narrowing or other forms of airway obstruction: COPD, Aspiration, Tumors (C) – Impaired host defense
Signs and symptoms
- Chronic productive cough producing large amount of sputum (lasting months to years ) Hemoptysis(coughing blood) usually mild, however Some people might have a dry cough with no or very little sputum.
- Wheeziness and shortness of breath
- Chest pain
- Fatigue and clubbing of fingernails
- Chest CT scan: most common test for diagnosis, it shows precise the structure of the airways, extent and location of the damage
- Chest X-ray
- Other tests: Sputum culture, Blood test, Sweat test, Bronchoscopy
Antibiotics: some can be inhaled by a nebulizer (ciprofloxacin, tobramycin) , and oral macrolides (Azithromycin), beta lactams (amoxiclav, ceftriaxone).
Mucus thinning medications: usually mixed with hypertonic saline solution and given as nebulizers to dissolve mucus in bronchi and ease coughing up, for non-CF bronchiectasis Dornase-alfa is used.
Bronchodilators: such as beta 2- adrenergic agonists(albuterol, formoterol], anticholinergic (tiotropium) and theophylline
Airway clearance methods: such as chest physiotherapy and positive expiratory pressure
Vaccination: with seasonal influenza and pneumococcal vaccines
Miscellaneous treatments Surgery, embolisation when there’s hemoptysis, smoking cessation, lung transplantation
Treatments under clinical trial: Ultra low doses of Melphalan for non-CF bronchiectasis, high frequency chest wall oscillation, randomized open-label trial of hypertonic saline and Carbocisteine, acetylcysteine and Ambroxol HCl as expectorants, Tobramycin for Pseudomonas Aeruginosa colonized bronchiectasis
Living with Bronchiectasis
Early diagnosis prevents further damage to lungs and people with bronchiectasis should have ongoing care and try to follow healthy lifestyle, and emotional support is important due to the depression and anxiety that a chronic disease such and Bronchiectasis is usually accompanied with.