All you need to know about bronchiectasis

Dr Maxwell Adeyemi

BRONCHIECTASIS is a lung condition where the airways (tubes going into the lungs) get damaged and widen. Damaged airways cannot clear mucus like they are supposed to anymore. Bacteria then grows in the mucus, causing more inflammation and damage to the lungs. This makes the patient cough a lot as the body tries to remove the infected mucus. Bronchiectasis and bronchitis have similar symptoms, including mucus in the lungs and coughing. But bronchiectasis causes permanent widening of the airways and bronchitis is a temporary infection that doesn’t cause lasting damage.

Types of bronchiectasis

Bronchiectasis can be categorised based on what the damage to the airways looks like – cylindrical (or tubular), varicose or cystic.

Cylindrical bronchiectasis is the most common and least serious form of bronchiectasis, while cystic bronchiectasis is the most severe form.

Bronchiectasis can also be classified as focal (in one area) or diffuse (in many areas throughout the lungs). Traction bronchiectasis happens when scarring in the lungs pulls the airways out of shape.

How brobchiectasis damages the lung

The tubes (airways or bronchi) going into the lungs have defences to protect you from disease; mucus is one of these defences. When mucus cannot be coughed out, it causes lasting damage to your airways.

When you breathe air in, any harmful particles get trapped in mucus in your airways. Then, millions of tiny, hairlike structures (cilia) use a co-ordinated motion to move the mucus out of your lungs, like waves bringing debris to the shore. This is called mucociliary clearance. You cough out the mucus or swallow it, where the trapped particles are destroyed by your stomach acid.

When any part of this system is not working, if the cilia in the lungs are damaged or the airways have pockets that trap mucus, there will be a build up of mucus in the lungs. The mucus has bacteria trapped in it, which can multiply and cause infections. The damage the infections cause can make bronchiectasis worse.

Bronchiectasis can be mild or severe depending on how much damage you have in your lungs. Some people have it and don’t even know it. Others have had it for a long time and repeated infections have severely damaged their lungs. Most people with bronchiectasis live a normal lifespan by managing their symptoms with their physician’s advice and medication.

Symptoms

Symptoms of bronchiectasis include:

Cough with lots of mucus and pus, repeated colds, bad-smelling mucus, shortness of breath (dyspnea), wheezing, coughing up blood (hemoptysis), swollen fingertips with curved nails (nail clubbing).

Other symptoms include: extreme tiredness (fatigue), fever, chills and night sweats.

Causes of bronchiectasis

Bronchiectasis is caused by two phases of airway damage.

In the first phase, the initial damage or “insult” is caused by an infection, inflammatory disorder or another condition that affects your lungs.

The first insult makes you more likely to get inflammation and repeated infections that cause further damage to your lungs, which results in the second phase and creates a “vicious cycle.”

Conditions that cause bronchiectasis

* Mycobacterial infections, or tuberculosis.

* Autoimmune or inflammatory disorders, like rheumatoid arthritis, inflammatory bowel disease, lupus and Sjögren's syndrome.

* Foreign bodies, tumours or lymph nodes that block airways and prevent mucus clearance.

* Conditions that decrease immunity and increase risk of infections like HIV and hypogammaglobulinemia.

* Primary ciliary dyskinesia.

* Organ transplant. Transplant medications decrease immunity and can increase risk of infection and bronchiectasis.

* Allergic bronchopulmonary aspergillosis, an allergy to a type of fungus.

* Fibrosis (scarring) of the lung from radiation.

* Enzyme Alpha-1 antitrypsin deficiency.

Diagnosis

A number of tests to diagnose bronchiectasis or rule out other conditions can include:

* Chest CT scan or X-ray

* Blood tests and sputum cultures

* Lung function tests

* Genetic testing

* Sweat chloride test – a test for signs of cystic fibrosis

* Bronchoscopy

Treatment

Bronchiectasis cannot be fully cured, but you can treat the symptoms.

If bronchiectasis is caused by an underlying condition, treating that condition may help your symptoms. Bronchiectasis treatments help get rid of infected mucus, kill bacteria and decrease inflammation. They include:

* Antibiotics. Antibiotics can treat infections caused by bacteria.

* Macrolides. Macrolides are drugs that treat infections and inflammation at the same time.

* Expectorant and mucolytics. These are medications that thin mucus and help you cough it out.

* Physical therapy. Postural draining and chest percussion therapy can help loosen and remove mucus. Breathing exercises can help open up your airways.

* Medical devices. Oscillating positive expiratory pressure (PEP) devices and percussive vests break up and pull mucus out from your lungs.

Reducing your risk

You can reduce your risk of developing bronchiectasis by managing your lung health:

* Ensure you are up to date on recommended vaccinations. Pertussis, the flu, pneumococcal disease, measles and staph infections can all cause or worsen bronchiectasis.

* Treat any ongoing health conditions, especially ones that affect your lungs.

* Avoid breathing in things that can hurt your lungs, like cigarette smoke, vaping, fumes and gases.

Damage caused by severe bronchiectasis can lead to life-threatening complications, including:

* Respiratory failure: If your lungs are not working properly, you might not be able to get enough oxygen to your blood and tissues, causing respiratory failure.

* Severe bleeding: Blood vessels in your airways may get so damaged that they bleed heavily. You may cough up blood if this happens.

Antibiotic resistance: You may use antibiotics so much that you start getting infections that can no longer be treated with medication, so it is important not to self-medicate on antibiotics every time you feel sick but rather consult with your doctor.

If you have been diagnosed with bronchiectasis, you should contact your physician if you:

* Have signs of infection, like a fever or chills.

* Have more trouble breathing than usual.

* Are much more tired than usual.

* Are losing weight unintentionally.

* Are coughing up more mucus, mucus with blood in it or mucus that is yellow or green.

* Don’t have an appetite.

These are red flags that may indicate the need for more proactive actions and prompt treatments.

Contact Dr Maxwell on 3631807 or 7575411