BRONCHIECTASIS

Bronchiectasis is a chronic incurable lung disease problematic for the bronchial tubes (passages that carry air into the lungs). The breathing tubes become abnormally dilated and small “pockets” form in the walls of tubes. These “pockets” are susceptible to pooling of mucus and germs which become inflamed and infected.

Usually there is no fever or pain but if the small infection is not treated, it can become a large, more serious infection which may then be associated with cough, chronic sputum production, hemoptysis (bloody sputum), recurrent fever, shortness of breath, and chest pain (pleurisy). Many cases of bronchiectasis start with chronic or acute respiratory disease such as severe influenzae (virus), severe childhood or adult pneumonia, and tuberculosis. Other causes include some type of obstruction which causes injury to the bronchial tubes and the tiny hairs called cilia that line the tubules and sweep them free of dust, mucus, and germs. Without this cleaning mechanism, infection and bronchiectasis results. This damage can also be caused by smoking or inhalation of toxic chemicals.

Some bacteria commonly associated with bronchiectasis include: Pseudomonas aeruginosa,Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, fungus such asAspergillus, and nontuberculous mycobacteria including Mycobacterium abscessus and MAC. These infections may be chronic or recurrent and the doctor may prescribe antibiotics to control such complications.

Bronchiectasis may be misdiagnosed as chronic bronchitis or chronic obstructive pulmonary disease (COPD). Appropriate diagnostic approaches include a complete history and physical examination, sputum cultures, and pulmonary function tests [forced expiratory volume in 1 second (FEV1) and full vital capacity (FVC)]. Imaging tests including chest x-ray and High Resolution Computed Tomography (HRCT) should also be ordered. The HRCT is the most reliable method of diagnosis as the chest x-ray fails to show bronchiectasis in more than half of the cases. Three out of four cases of bronchiectasis are diagnosed in patients 65 years or older.

Genetic factors also play a role in the development of bronchiectasis in diseases such as cystic fibrosis and alpha one antitrypsin deficiency.
A good discussion of mucus clearance for patients with bronchiectasis, including devices such as the flutter valve and the pneumatic vest, and procedures is available at http://www.ntminfo.com.

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