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Wednesday, May 16, 2012

What is bronchiectasis?

Bronchiectasis is a disease that causes the air passages (bronchioles) in the lungs to become abnormally widened or dilated and inflamed or swollen.  This makes it so the patient is unable to clear secretions from their lungs, these secretions become abnormally thick, and this creates a breeding ground for bacteria.

This is a condition commonly associated with cystic fibrosis patients as that disease progresses.  Usually these patients have to take prophylactic antibiotics to prevent pneumonia, and during exacerbations of their condition IV antibiotics are often required to fight off lung infections.

Exacerbations generally include the following symptoms:

  • Cough
  • Increased sputum production
  • Sputum may be thick and chunky
  • Sputum may contain blood
  • Sputum may be colorful and putrid
  • Short of breath (dyspnea)
  • Wheezing
  • Sinus infections (often resulting in sinusitis)
This condition is caused as the result of an infection, often early in life, that causes the lungs to become inflammed and this inflammation becomes permanant.  This causes permanant widening of the air passages and future exacerbations occur.  

Since cystic fibrosis patients are prone to have this secretions this makes them susceptible to lung infections, and this is believed to cause bronchiectasis. Each progressive lung infection can make the condition worse, and this is why early diagnosis and treatment is essential.  

While most cystic fibrosis patients have bronchiectasis, you don't have to have cystic fibrosis to have bronchiectasis.

It's usually the bronchiectasis component of cystic fibrosis that causes these patients to die at a young age.  Yet thanks to modern wisdom, better antibiotics and prophylactic care, these patients are now living into their 30s.

Some people do develop this condition later in life, and these patients are also able to live longer with the condition thanks to modern wisdom and better medicines available to treat this condition.

Usually you'll see these patients come to the hospital at least once a year for their yearly recharge.  Treatment usually consists mainly of:  
  • Antibiotics to treat infection
  • Bronchodilators to treat bronchospasm
  • Mucus thinners to chop up thick secretions
  • Chest physiotherapy to help bring up secretions
  • Mucus clearance devices such as chest wall oscillatorsAcapella and flutter valves
  • Underlying condition should also be treated.
Besides cystic fibrosis, there are other conditions that can cause bronchiectasis, including:
  • Viral infections
  • Bacterial infections
  • Tuberculosis
  • Fungal infections
  • Immune deficiencies (make person more susceptible to lung infections)
  • Aspiration (GERD, oralpharyngeal dysphagia)
  • Rheumatoid arthritis
  • Lupus
  • Primary ciliary dyyskinesia
  • Alpha 1 antitrypson deficiency
  • Lung tumors
  • COPD
Diagnosis may involve a patient assessment, medical history, cat scan of the lungs, and pulmonary function testing, and consideration of any underlying medical conditions such as listed above.  



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