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Bronchiectasis

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Definition

Bronchiectasis is abnormal dilation and widening of the large airways (bronchial tubes) of the lungs due to destruction of the lung tissue.

This reduces the capacity of the airways to clear mucus, predisposes the lung tissue to recurrent inflammation and thus further damages the lung. Bronchiectasis may develop in multiple areas in one or both lungs.

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Types

  • Congenital Bronchiectasis - present at birth due to defect in the structure of lung tissue.
  • Acquired Bronchiectasis - may be acquired in later life due to:
    • Recurrent inflammation or infection of the lung tissue e.g. cystic fibrosis, pneumonia, fungal infections, asthma
    • Accidental inhalation or swallowing of a foreign object.

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Causes

  • May be present at birth due to congenital or birth defect in the lung tissue.
  • Obstruction of the airway due to accidental inhalation or swallowing of a foreign object e.g. coins, small toys, marbles, pins, screws, rocks, nuts, seeds, popcorn, buttons, beads, bone fragments.
  • Lung Tumors
  • Recurrent severe bacterial lung infections e.g. pneumonia, tuberculosis, chronic bronchitis, fungal infections
  • Abnormalities of the immune system
  • Cystic Fibrosis
  • Asthma

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Symptoms

  • Chronic cough
    • Accompanied by large amounts of foul-smelling yellow or greenish sputum
    • Worsened by lying on one side
    • Hemoptysis (coughing up of blood)
  • Foul odor in the breath
  • Difficulty breathing (breathlessness) especially worsened by exertion, strenuous activity or exercise
  • Wheezing
  • Paleness
  • Weight loss
  • Fatigue
  • Clubbing of fingers due to abnormal amount of tissue in the fingernail beds
  • Bluish discoloration of skin or cyanosis
  • Chest pain

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Implications

Bronchiectasis can be severely debilitating and progressive. One of the commonest complications of bronchiectasis is Cor Pulmonale. Cor pulmonale is a condition characterized by the failure of the right side of the heart (right ventricle) caused by prolonged high blood pressure in the pulmonary artery. When the right ventricle of the heart is unable to pump the blood against the high blood pressure in the pulmonary artery, there is prolonged inadequate oxygenation of the blood. Any chronic lung condition like bronchiectasis, recurrent severe bacterial pneumonia or asthma can cause cor pulmonale. Hemoptysis or coughing up of blood can result in anemia, fatigue and weakness.

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What You Can Do

  • Emergency Measures
    • Relieve airway obstruction immediately by removing the inhaled or swallowed object from the nose, mouth or throat
    • Seek medical help or call 911 if there are signs of respiratory distress like rapid and labored breathing, gasping for air, choking, coughing or cyanosis of lips and fingertips.

  • Medications
    • Antibiotics - To treat or prevent bacterial lung infections
    • Bronchodilators - If the condition is associated with asthma
    • Expectorants - To loosen the mucus so that it can be coughed out.

  • Drainage of Bronchial Secretions
    • The patient can be trained by a respiratory therapist to effectively remove and drain excess bronchial secretions on a daily basis. This includes postural drainage techniques and coughing exercises.

  • Surgical Treatment
    • Surgical resection of the affected part of the lung may be performed in those cases who fail to respond to treatment or if there are frequent and massive bouts of hemoptysis.

  • Consult your physician if:
    • There is no response to treatment
    • The symptoms have worsened
    • There is increase in the intensity of chest pain
    • Breathing difficulty has increased
    • There is blood in sputum
    • There are frequent and massive episodes of hemoptysis

  • Prevention
    • Avoid upper respiratory tract infections
    • Treat lung infections promptly
    • Avoid exposure to dusty and polluted environments
    • If you are a smoker, quit smoking

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Bronchiectasis