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Bronchiectasis

brochiectasis

Bronchiectasis is an abnormal widening of one or more airways. Extra mucus is made in the abnormal airways which is prone to infection. The main symptom is a cough which produces a lot of sputum.

Air passes into the lungs via the windpipe (trachea) which divides into a series of branching airways called bronchi. Air passes from the bronchi into millions of tiny air sacs (alveoli). Oxygen from the air is passed into the bloodstream through the thin walls of the alveoli. Tiny glands in the lining of the airways make a small amount of mucus. The mucus keeps the airways moist but also traps any dust and dirt in the inhaled air.

What is bronchiectasis?

Bronchiectasis is a permanent abnormal widening (dilation) in one or more of the airways (bronchi). Extra mucus tends to form and pool in the parts of the airways that are widened. Widened airways with extra mucus are prone to infection.

The widened parts of the airways are damaged and inflamed. This causes extra mucus to form which is less easily cleared. The severity of symptoms depends on how many of the airways are affected and how badly. The lung tissue next to a badly inflamed section of airway may also become inflamed and damaged.

What causes bronchiectasis?

The cause is often not clear and no cause can be found in over half of cases. Some conditions that affect or damage airways can cause bronchiectasis. Examples include the following:

  • Severe lung infections such as tuberculosis (TB), whooping cough, pneumonia or measles, which can damage the airways at the time of infection.
  • 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, which is regurgitated and inhaled, can damage airways.
  • Inhaling poisonous gases may also cause damage.
  • Some diseases that cause inflammation in other parts of the body can occasionally cause inflammation and damage in the bronchi and lead to bronchiectasis. For example: ulcerative colitis, Crohn's disease, coeliac disease, rheumatoid arthritis, systemic lupus erythematosus.

What are the symptoms of bronchiectasis?

Coughing up lots of sputum is the main symptom. The amount of sputum can vary, depending on the severity. Tiredness and poor concentration are common. Wheezing is common. Some people become breathless, particularly when exercising or exerting themselves. You may cough up some blood from an inflamed airway. Recurring chest infections are common. Sputum turns greeny/yellow when it is infected.

How is bronchiectasis diagnosed?

If your symptoms suggest bronchiectasis then the diagnosis can be confirmed by a CT scan. A CT scan can determine the width of the bronchi. Widened bronchi seen on a CT scan confirm bronchiectasis. Various other tests may be advised if an underlying cause is suspected.

What are the treatments for bronchiectasis?

Antibiotics

Antibiotics are the mainstay of treatment. If you have mild bronchiectasis, you are likely to need a course of antibiotics every now and then to clear chest infections as and when they occur.

Physiotherapy and other exercise therapies

The aim of physiotherapy and other exercise therapies is to help you to cough up and clear the mucus and to improve your overall lung fitness. Typically, people with bronchiectasis are encouraged to perform their chosen airways clearance therapy for 20-30 minute, once or twice a day. In addition, if you are able, a daily exercise activity such as running, brisk walking, swimming, dancing, aerobics, etc, may help to clear the mucus too and help you to keep fit.

Other medicines and immunisation

Leukotriene receptor antagonists may reduce the inflammation that occurs in the airways with bronchiectasis. Immunisation against the pneumococcus bacterium.

Inhalers

Bronchodilator inhalers are commonly used in asthma to relax and open wide (dilate) the airways. They are also useful if the wheezing and breathlessness of bronchiectasis become severe. There are a number of types - for example, salbutamol inhaler.

Do not smoke

Smoking makes symptoms worse and smokers are very strongly advised to stop. Also, avoid passive smoking - that is, breathing in the smoke from people smoking nearby.

Surgery

Cutting out the damaged airway may cure the problem. Surgery may be considered even if you have widespread bronchiectasis. This may be to cut out a particularly bad area of lung that is acting as a reservoir for mucus and infection. A lung transplant may be considered in severe cases.

What is the outlook?

Most people with bronchiectasis  have a good outlook. Symptoms in many affected people do not become severe. The outlook for people where bronchiectasis is part of another condition depends on the underlying cause.


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