BRONCHIECTASIS
What is Bronchiectasis?
Bronchiectasis comes from the Greek words "bronckos"
(airway) and "ektasis" (widening). In bronchiectasis damage to the airways
causes them to become enlarged. Such damage results when the complex cleaning system of
tiny hairs called cilia which are part of the cells lining the airways are damaged or
destroyed. Mucus cannot then be cleared easily from the lung. This allows infection which
leads to damage to the airways. The condition usually affects young people more frequently
than adults. It is becoming much less common as treatment programs for infection become
more effective.
What causes it?
Many cases of Bronchiectasis begin with pneumonia due to viruses
such as influenza and measles or bacteria such as whooping cough or tuberculosis. Some
people whose ability to resist infection is reduced or whose immune system is not working
properly, are also prone to this condition. Bronchiectasis may also occur in patients who
have difficulty coughing up mucus (eg. cystic fibrosis). Blockage of an airway with any
inhaled tiny object such as a peanut will lead to Bronchiectasis if left untreated.
What are the symptoms?
Most of the time patients feel well. The main symptom is a cough
producing mucus (sputum). The mucus is often foul smelling causing bad breath and
occasionally blood may be coughed up as well. Head colds develop easily into pneumonia and
many cases have nose and sinus problems. Many adults notice tiredness and weakness and
often feel "below par". During times of chest infection, the amount of mucus
increases and moist crackling noises may be heard in the chest.
What tests do I need?
A chest x-ray may not always show changes suggestive of
Bronchiectasis. Detailed x-rays called CT scans are sometimes needed to make the diagnosis
and to show which part of the lung is involved. Testing specimens of sputum may be helpful
in identifying which germs are causing infection and allow for a sensible choice of
antibiotic. Other tests are used to detect cystic fibrosis and deficiencies in immunity
and the ability to resist infections. Your doctor will arrange breathing tests from time
to time to help monitor the progress of your condition.
What problems can develop?
Coughing can be embarrassing for teenagers and adults. The cough
is usually due to accumulation of sputum within the airways and is most effectively
treated with regular physiotherapy. Infection in Bronchiectasis may be caused by many
germs but in more longstanding cases, infections with staphylococcus and pseudomonas
species may become a problem requiring special antibiotic therapy. Coughing up blood may
occur from time to time and usually indicates infection. Coughing up large quantities of
blood is frightening although rarely serious. However, medical attention should be sought
immediately if this occurs. Patients with bronchiectasis commonly develop chest
infections, as a result of minor upper respiratory tract infections such as the common
cold. In patients with advanced bronchiectasis breathlessness is a common feature
particularly during times of infection.
What can be done about it?
The aim of treatment is to clear mucus from the chest. In the
majority of cases, symptoms can be very effectively treated with physiotherapy and
exercise programs. An individual program can be developed with a physiotherapist and may
include physical exercise, postural drainage of the chest, active breathing, huffing,
coughing or other physiotherapy techniques. Exercise can be combined with the inhalation
of a bronchodilator - a medicine which helps to open up the airways. If a lot of sputum is
being produced, postural drainage, where the body is positioned so that gravity helps to
drain sputum from the lungs, can be combined with the breathing exercises. All
bronchiectatic patients are susceptible to infections, such as acute bronchitis and
pneumonia, during which sputum becomes coloured and blood may be coughed up. Prompt
antibiotic treatment is usually required which sometimes needs to be given in hospital.
Bronchodilator medicines such as AtroventTM , BricanylTM,
VentolinTM are sometimes helpful. Inhaled corticosteroid drugs (eg. AldecinTM, BecotideTM,
BecloforteTM, PulmicortTM, FlixotideTM) and occasionally corticosteroid tablets may be
used. In severe cases, oxygen may also be helpful. Medicines which help to liquefy mucus
(mucolytics) cannot clear up pockets of infected mucus. They are not helpful in most
cases. For some patients operations may occasionally be necessary.
How can it be prevented?
Children should be vaccinated against measles and whooping cough.
Special care should be taken to make sure that infants, children and adults recover
completely from any pneumonia. Infants and children should be protected against
accidentally breathing in small objects. If anything does happen "to go down the
wrong way" and cannot be coughed out, a doctor should be contacted immediately.
Adults with bronchiectasis should also be encouraged to have a vaccination against
influenza each year and against pneumococcal pheumonia where appropriate.
What happens over the years?
Enjoyment of life with a normal span occurs in most cases.
Patients with severe disease can develop breathlessness and low exercise tolerance but the
majority remain stable for many years. Cases with cystic fibrosis often have more severe
Bronchiectasis. Active physiotherapy and exercise programs improve the quality of life and
reduce the number of episodes of infection and hospital admissions. Prompt antibiotic
therapy at times of infection and regular review by your doctor are also strongly
recommended.
Please Note: This information
is intended by The Australian Lung Foundation to be used as a guide only and is not
an authoritative statement. Please consult your family doctor or specialist respiratory
physician if you have further questions relating to the information provided here.
