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Bronchiectasis: Causes, Symptoms and Treatment

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Bronchiectasis is a lung condition that causes coughing up of mucus. It is (pronounced brong-kee-ek-tuh-sis).

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This is a disorder in which the air passage called bronchial tubes in the lungs is permanently weakened, expanded, and thickened. These weakened bronchial tubes cause bacteria and mucus to build up and accumulate in the lungs. This results in repeated infections and airway blockages.

In the lungs, the bronchial passages allow air to enter the lungs. In bronchiectasis, the bronchi’s inner surfaces grow smoother over time due to inflammation that causes scars.

In these passages, thicker walls allow mucus to accumulate because the walls are not solid enough to make the mucus travel out of the lungs. Besides, cilia (thin fibers that look like hair and help transfer mucus) is damaged.

When this occurs, infections can happen more quickly, and breathing becomes more difficult—Times, when breathing or coughing, is getting harder and are considered exacerbations.

There is no cure for bronchiectasis, but it can be managed. Typically, one can live everyday life with care. Simultaneously, flare-ups must be treated as soon as possible to preserve the oxygen supply to the rest of the body to avoid further lung damage.

It is estimated that there are about 500 000 people in the United States with bronchiectasis, and one in 150 people aged 75 and older has bronchiectasis. The risk of this condition rises with age.

However, younger people can and may get bronchiectasis. It is much more common in women than in men and adults. It is more common in boys than in girls.

In children, it is more common in boys than in girls. Although it can be rare, some children are born with bronchiectasis.

Causes of bronchiectasis

Any injury to the lungs can result in bronchiectasis. There are two main types of this condition. Bronchiectasis may be caused by cystic fibrosis (CF) and can be known as CF bronchiectasis.

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CF is a genetic condition that can result in the abnormal production of mucus. It is a long-lasting lung infection and causes the inability to breathe. This kind of bronchiectasis can get worse over time.

For non-CF bronchiectasis, the cause is usually unknown. This is known as idiopathic bronchiectasis. Nonetheless, in other cases, causes can include:

  • Breathing in or aspirating things like fluids, stomach acid, or foods into the lungs
  • An allergy to a specific type of fungus called Allergic bronchopulmonary aspergillosis.
  • Past severe infection that has destroyed the lung
  • Hereditary diseases like primary ciliary dyskinesia or alpha-1 antitrypsin deficiency
  • Immune system conditions or an abnormal functioning immune system that can not fight off infections easily
  • Other conditions can include Sjogren’s syndrome, rheumatoid arthritis, and Crohn’s disease
  • Obstructed airways by something like a tumor or an inhaled object
  • Some lung infections, like whooping cough and tuberculosis
  • Human immunodeficiency virus (HIV) 
  • Chronic obstructive pulmonary disease (COPD)
  • Inflammatory bowel infection

Symptoms of bronchiectasis

Symptoms of bronchiectasis can take months or even years to develop. Some symptoms include:

  • Coughing up a lot of mucus daily
  • Coughing up mucus and blood, a condition called hemoptysis
  • Abnormal wheezing or other sounds in the chest while breathing
  • Shortness of breath
  • Chest pain and hardness, which is caused by breathing difficulty
  • Coughing up large quantities of thick mucus every day
  • Weight loss
  • Clubbing [ change in the structure of the finger and toe nails]
  • Frequent respiratory infections
  • Drastic weight loss
  • Flare-up that usually results in
    • Fevers or chills
    • Fatigue 
    • Increased shortness of breath
    • Night sweats

Bronchiectasis diagnosis

A computed tomography scan on the chest, or chest CT scan, is a common test for diagnosing bronchiectasis since a chest X-ray cannot provide sufficient detail.

This test is usually painless, and it seeks to create precise pictures of the airways and other parts of the chest. A chest CT scan can display the extent of the lung damage and its exact location.

If bronchiectasis is confirmed with the chest CT scan, the doctor will try to determine the bronchiectasis cause based on physical exam findings and history.

It’s imperative to know the exact cause so the doctor can treat the underlying disorder to prevent the bronchiectasis from getting worse. Different causes can trigger or contribute to bronchiectasis.

The evaluation for the underlying cause usually consists of laboratory and microbiologic testing and pulmonary function testing. The initial evaluation will include:

  • Complete blood count with differential
  • A sputum culture can be conducted to check for bacteria, mycobacteria, and fungi
  • Immunoglobulin levels (IgG, IgM, and IgA)

If your doctor suspects CF, they request a genetic test or sweat chloride test.

Treatment options for bronchiectasis

Specific therapies can make the progression of bronchiectasis related to some conditions slow.

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The conditions are mycobacterial infections, allergic aspergillosis, certain immune deficiencies, cystic fibrosis, recurrent aspiration, and possibly autoimmune diseases.

Generally, there is no cure for bronchiectasis, but treatment is essential to manage the condition. The main objective of treatment is to keep infections and bronchial secretions under control.

It’s also important to stop further obstructions of the airways and reduce lung damage. Common ways of treating bronchiectasis include:

  • Carrying out breathing exercises to clear the airways or draining the bronchial of secretions by using gravity. A respiratory therapist can teach the patient techniques to aid in coughing up the excess mucus.
  • Getting vaccinations to prevent respiratory infections
  • Taking medications to thin mucus
  • Using antibiotics to treat is the most common treatment option for this condition. Oral antibiotics can be prescribed for some cases, but complicated bronchiectasis cases can require intravenous (IV) antibiotics. An example is Macrolides, which are a specific type of antibiotics that not only kill certain types of bacteria but also decrease inflammation in the airways. They can be beneficial for severe cases, but they have extreme side effects.
  • Undergoing pulmonary rehabilitation
  • Undergoing oxygen therapy
  • Taking bronchodilators like tiotropium (Spiriva) and albuterol (Proventil) to open up airways
  • Using expectorants to aid in coughing up mucus
  • There might be a need for chest physiotherapy. One type is a high-frequency chest wall oscillation vest to help clear your lungs of mucus. The vest systematically compresses and releases the chest, forming the same effect as a cough. This can clear out mucus from the walls of the airways.
  • If bronchiectasis is only in one part of the lung or there is bleeding, surgery may be needed to remove the infected area.
  • If conditions like immune disorders or COPD cause bronchiectasis, the doctor will also treat those underlying conditions.

Risk factors for bronchiectasis

People with the following conditions are considered to be at a higher risk of getting bronchiectasis

  • Chronic lung infections, like tuberculosis, non-tuberculous mycobacteria (NTM) or pneumonia
  • Deficiency in the immune system
  • Frequent aspiration (breathing in) of things other than air, such as food particles, that cause damage to the lungs
  • Chronic and inflammatory lung disease
  • Cystic fibrosis

Prevention of Bronchiectasis

The exact cause of bronchiectasis is unknown, especially in non-CF bronchiectasis. For some, it’s related to genetic anomalies and other medical conditions that can affect the lungs.

Avoiding smoking cigarettes, polluted air, cooking fumes, and chemicals can help protect the lungs and preserve lung health.

One should get vaccinated against measles, whooping cough, and flu, as these conditions are risk factors for adults’ condition.

But often, when the cause is not known, prevention is difficult. Early detection of bronchiectasis is important so that it can be managed before significant lung damage occurs.

How to Manage Bronchiectasis

Bronchiectasis is a long-term condition with symptoms that need to be managed for many years. Patients are advised to work closely with a doctor to define healthy habits that will reduce flare-ups.

Some of the doctor’s suggestions may be:

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  • Stop smoking completely and avoid inhaling secondhand smoke.
  • Observe healthy eating habits by incorporating meals low in sodium, added sugars, saturated fats, and refined grains.
  • Drinking plenty of water and staying hydrated can prevent mucus build-up.
  • Taking oral and inhaled medications and performing mucus clearance techniques diligently as prescribed by the doctor.
  • Taking vaccinations regularly and antibiotics for 7 to 14 days during flare-ups.

Despite pursuing a healthy lifestyle, occasional flare-ups may happen. This often occurs because of a new respiratory infection or overgrowth of bacteria.

You might experience symptoms like increased mucus production that is bloody or a varied color, fatigue, weight loss, shortness of breath, and fever.

In these instances, one should contact the doctor immediately.

Questions to ask your doctor

Make a note of questions you would like to ask your doctor during your appointment. You can also include the listed below questions.

  • How advanced is my disease?
  • Am I contagious? Are my family members at risk?
  • How often would I need to provide a sputum sample for culture at the laboratory?
  • What are the signs and symptoms of a flare-up that i might experience?
  • What should I do when I experience a flare-up?
  • Are there things or medication I can take to prevent a flare-up?
  • How long does it take for the medication to kick in? What should I do when I don’t feel better? What are the side-effects of the medication?
  • Should I take over-the-counter cough and cold products?
  • Can you recommend anything that can provide me with the emotional support of having lung disease?
  • What habits or diets do you recommend to manage my condition better?

Reference;

  • Bronchiectasis; Causes, symptoms and Diagnosis: Healthline
  • Bronchiectasis; Causes,symptoms, treatment and prevention: Cleveland Clinic
Bronchiectasis
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Jennifer Aigbini
I am a language enthusiast, studying Linguistics at the University of Benin, in Nigeria.
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