Bronchiectasis
Definition
Bronchiectasis is a congenital or acquired disorder of the large bronchi of the lungs, characterized by permanent, abnormal dilation and destruction of bronchial walls.
Description
Bronchiectasis is a lung condition in which some of the bronchi and bronchioles have lost their elasticity and have expanded and filled with fluid. It may be caused by recurrent inflammation or infection of the airways and is primarily a disorder of childhood and young adulthood, with most cases being recognized during the first 2 decades of life.
Causes
Cystic fibrosis causes about half of all cases of bronchiectasis. Other causes include lung infection (tuberculosis, fungal infections, lung abscess, pneumonia), abnormal lung defense mechanisms (immunodeficiency, rheumatic disease), and localized airway obstruction (foreign body, tumor). Acquired primary bronchiectasis is now uncommon in the U.S. because of improved control of bronchopulmonary infections through the use of antibiotics..
Symptoms
The most typical symptom is a chronic cough that produces thick, white or green sputum (discharge). The sputum may be foul-smelling and abundant and may contain blood. The individual generally coughs up large amounts of sputum after changing position (for example, after rising from bed). The patient may have recurrent pneumonia, weight loss, and anemia.
Diagnosis
The doctor, listening to the chest with a stethoscope, can usually hear abnormal sounds inside the lungs as the patient breathes. Sputum smears and cultures may be ordered. A chest X-ray or high-resolution CT (computed tomography) scan may be done. Chronic bronchitis must be ruled out as a cause, along with tuberculosis, certain fungal infections, a tumor, and the presence of an inhaled object that is lodged in a bronchi.
Treatment
Treatment of an active case of bronchiectasis includes fighting the infection with an antibiotic and eliminating the fluid with postural drainage and chest physiotherapy. In the latter procedure, the patient lies face down in bed, with pillows elevating the hips, and a therapist strikes the back over the lungs with cupped hands to loosen mucous. The treatment, which can be taught to a family member, requires two to four ten-minute sessions a day. Inhaling warm mists may also help to moisten the thick mucous clogging the airways, so that it can more easily be expelled. The patient should avoid anything that can irritate the lungs, such as tobacco smoke, fumes, and dust. An inhaled bronchodilator may be prescribed. In the relatively few cases in which the infection is confined to a small part of the lung and is progressing despite the administration of antibiotics and other forms of therapy, it may be best to perform bronchoscopy (viewing the bronchi via a tube inserted through the mouth) or to surgically remove the affected portion of the lung.
Questions
What tests need to be done to diagnose the condition and the cause? What is the cause? How much permanent damage has been done and how serious is it? What treatment do you recommend? Will any medication be prescribed? What are the side effects? At some point will surgery be required? What is the procedure? What home treatments can be performed to help improve the condition? What is the prognosis?
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