Presentation
Workup
Treatment
The major goals of therapy in dealing with bronchiectasis are as follows [9]:
- Improvement of symptoms
- Reduction of complications
- Control of exacerbations
- Reduction of morbidity and mortality
Early recognition is very important when dealing with bronchiectasis and other related conditions. Also, the management of underlying conditions is very important in the overall treatment of the condition. This may include the use of intravenous immunoglobulin or intravenous alpha1-antitrypsin (AAT) therapy.
Antibiotics as well as chest physiotherapy are very important parts of modalities. Other modalities are:
- Bronchodilators
- Corticosteroid therapy
- Dietary supplementation
- Oxygen or surgical therapies
Patients with severe exacerbations of this condition can be treated on admission with a combination of these therapies.
Prognosis
Given the difficulty in identifying prevalence and the lack of definitive studies, it is fairly difficult to estimate current mortality [6]. Generally though, prognosis for patients with bronchiectasis is good. However, it varies based on the type of underlying or predisposing condition. Bronchiectasis associated with cystic fibrosis has the worst form of prognosis.
Etiology
There are many etiologic factors for bronchiectasis. Some of them are [3]:
- Pulmonary infection
- Aspergillosis
- Alpha-1 antitrypsin deficiency
- Aspiration
- Autoimmune disease
- Bronchial obstruction
- Congenital anatomic defect
- Cystic fibrosis
- Malignancy
- Idiopathic inflammatory disorder
- Immunodeficiency
- Primary ciliary dyskinesia
- Young syndrome
- Cigarette smoking
- Toxic gas exposure
Epidemiology
The documentation for this condition is poor around the world so it makes it difficult to have definitive figures for the incidence [4]. However, it is estimated that the condition affects 1 in 100,000 people.
There is no racial or sexual predilection as well.
Pathophysiology
Bronchiectasis refers to an abnormal dilation of the proximal and medium-sized bronchi [5]. It is often caused by the weakening or destruction of the muscular and elastic components of the bronchial walls. Affected areas may also show a variety of changes which may include transmural inflammation, edema, scarring as well as ulceration. The distal lung parenchyma is also prone to damage following persistent microbial infection or frequent postobstructive pneumonia. Bronchiectasis may be congenital but most of the time it is acquired.
Congenital bronchiectasis most of the time affects infants and children. These cases are as a result of developmental arrest of the bronchial tree.
Acquired forms of these is seen in adults or older children and often require an infectious insult, impairment of drainage, airway obstruction as well as a defect in host defence.
Prevention
The main way to prevent the development of bronchiectasis is to avoid smoking or drop the habit [10]. Individuals struggling with dropping the habit can be put on tobacco cessation programs as soon as possible.
Occupational exposure to chemical fumes and dust is another common cause of development of this condition. People who work with this kind of lung irritant should take precautionary measures to protect themselves such as the use of respiratory protective equipment.
Summary
Bronchiectasis is a pulmonary disorder that usually occurs following some type of infection [1]. The condition is rare and results in a permanent distortion of parts of the airways [2]. The disorder is marked by inflamed and easily collapsible airways, obstruction of airflow as well as shortness of breath and an incapability of clearing out secretions within the airways. In some cases hemoptysis can occur while the more severe cases can lead to respiratory failure. The ailment was first recorded in 1819 by Laennec, but over time the prevalence, and treatment of bronchiectasis has changed.
Patient Information
Bronchiectasis is an incurable chronic lung condition where the wall of the airway of your lungs become damaged, losing their ability to clear out mucus. As mucus builds up, bacteria have a favourable environment to grow in and this brings about repetitive lung infections that can bring damage to your airways.
Since the airways are responsible for the delivery of oxygen and expelling of mucus, this condition has serious consequences most of the time. Heart failure, abscess in the brain or even a collapsed lung are some examples of the consequences.
References
- Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Does failed chronic wet cough response to antibiotics predict bronchiectasis?. Arch Dis Child. Feb 12 2014.
- Tiddens HA. Chest computed tomography scans should be considered as a routine investigation in cystic fibrosis. Paediatr Respir Rev. Sep 2006;7(3):202-8.
- Young K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiol. Nov 1991;32(6):439-41.
- Smith IE, Flower CD. Review article: imaging in bronchiectasis. Br J Radiol. Jul 1996;69(823):589-93.
- Chalmers JD, McHugh BJ, Docherty C, Govan JR, Hill AT. Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis. Thorax. Jan 2013;68(1):39-47.
- Barker AF. Bronchiectasis. N Engl J Med 2002; 346:1383.
- Weycker, D, Edelsberg, J, Oster, G, Tino, G. Prevalence and economic burden of bronchiectasis [obstructive airways disease]. Clin Pulm Med 2005; 12:205.
- Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142:432.
- Loukides S, Bouros D, Papatheodorou G, et al. Exhaled H(2)O(2) in steady-state bronchiectasis: relationship with cellular composition in induced sputum, spirometry, and extent and severity of disease. Chest 2002; 121:81.
- Silva JR, Jones JA, Cole PJ, Poulter LW. The immunological component of the cellular inflammatory infiltrate in bronchiectasis. Thorax 1989; 44:668.