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Bronchiectasis - Causes and Symptoms

Other Names: Acquired Bronchiectasis, Congenital Bronchiectasis

Definition:

Bronchiectasis is an abnormal destruction and dilation (permanent or abnormal widening) of the large airways. This injury is the beginning of a cycle in which your airways slowly lose their ability to clear out mucus. The mucus builds up and creates an environment in which bacteria can grow. This leads to repeated serious lung infections. A person may be born with it (congenital bronchiectasis) or may acquire it later in life as a result of another disorder.

Causes of Bronchiectasis

Bronchiectasis is many a times caused by recurrent inflammation or infection of the airways. It may be present at birth, but most often begins in childhood as a complication from infection or inhaling a foreign object. Prior to the widespread use of immunizations, bronchiectasis was often the result of a serious infection with either measles or whooping cough. Now, viruses that cause influenza (flu) or influenza-like syndromes, may lead to development of bronchiectasis.

Some other Causes of Bronchiectasis may be:

  • Respiratory syncytial virus can cause bronchiectasis in some childs.
  • Some inherited conditions. For example, a condition called primary ciliary dyskinesia affects the cilia so they do not 'beat' correctly to clear the mucus. Cystic fibrosis is another condition that affects the lungs and causes 'bronchiectatic' airways.
  • Inhaled objects, such as peanuts, can become stuck and block an airway. This may lead to local damage to that airway. Acid from the stomach that is regurgitated and inhaled can also damage airways. Inhaling poisonous gases may also cause damage.
  • Some rare immune problems can also cause lung infections and damage to airways thereby causing bronchiectasis.
  • Severe lung infections such as tuberculosis (TB), whooping cough, pneumonia or measles can damage the airways at the time of infection. Ongoing bronchiectasis may then develop.
  • Less commonly, bronchiectasis may be caused by cystic fibrosis, an inhaled foreign body such as a peanut, following tuberculosis, or lung infection in Aids.
  • Other causes include inhalation of damaging gases, dust or smoke. The condition is worsened by smoking.
  • It is also seen in later life after severe lung infections such as pneumonia in childhood, and it is sometimes present from birth if the baby's lungs have not developed properly in the womb.

Symptoms of Bronchiectasis

Bronchiectasis can develop at any age and to any person. But, is most commonly seen in early childhood. Symptom severity varies widely from patient to patient and sometimes the patient may be even asymptomatic. In other people, symptoms begin gradually, usually after a respiratory infection, and tend to worsen over the years. The classic symptom, however, is a chronic cough that produces foul-smelling, mucopurulent secretions in amounts ranging from less than 10 ml/day to more than 150 ml/day. This finding is observed in more than 90% of bronchiectasis patients. There may be coughing spells - these are most common in the early morning and late in the day. Other characteristic findings include coarse crackles during inspiration over involved lobes or segments, dyspnea, sinusitis, anemia, malaise, clubbing, and other signs of infection.

Some other Symptoms of Bronchiectasis may be:

  • Cough worsened by lying on one side
  • Shortness of breath worsened by exercise
  • Weight loss.
  • Coughing up of blood is also common.
  • Fatigue.
  • Wheezing.
  • recurrent fever, chills,
  • Skin discoloration, bluish.
  • Paleness.
  • Abnormal chest sounds.
  • Breath odor.
  • There may be frequent bouts of pneumonia or hemoptysis.

Treatment for Bronchiectasis

Treatment of bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. Some of the Treatment options are given below:

  • Antibiotics may be given to the patient - orally or intravenously, for at least 7 - 10 days or until sputum production decreases. Long term antibiotic therapy is not appropriate because it may predispose the patient to serious Gram-negative infections.
  • Bronchodilators, combined with postural drainage and chest percussion, help remove secretions if the patient has bronchospasm and thick, tenacious sputum.
  • Bronchoscopy may be used to help mobilize secretions.
  • Hypoxia requires oxygen therapy; severe hemoptysis commonly requires lobectomy, segmental resection, or bronchial artery embolization if pulmonary function is poor.

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