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Bronchiectasis 2017-06-24T19:24:51+00:00
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About Bronchiectasis

When bronchial tubes become damaged, mucus builds up, spilling over into other tubes. These tubes are then more likely to be infected by bacteria. This causes inflammation and leads to damage called ‘bronchiectasis’. The most common symptoms are excessive phlegm, wheezy shortness of breath and long-term sinusitis.

The main symptom is recurrent chest infections, in which the patient develops a cough productive of green phlegm, and perhaps increased shortness of breath, fever, chest pains and malaise. In between infections, most patients will bring up some phlegm most days – small amounts of clear phlegm in milder cases, but patients with severe disease can produce large amounts of green and thick phlegm each day even when well. Patients with severe disease may also be short of breath when walking fast due to the underlying lung damage.

Bronchiectasis Causes

The commonest causes of bronchiectasis are:

  • Idiopathic (about 50% of patients); that is, we do not know why these patients have bronchiectasis. The presumption is that these patients have relatively minor defects in their ability to clear the lungs of infection, allowing bacteria to stay in the bronchi and cause damage. But we do not know for sure and so one important area of research is to work out why these patients develop bronchiectasis.
  • Post-lung infection. Childhood (and sometimes adult) lung infections such as tuberculosis, measles, whooping cough and pneumonia can leave behind areas of damaged lung with bronchiectasis.
  • Immune defects. Patients with low antibody levels or other problems with the immune system suffer from recurrent lung infections, which can lead to bronchiectasis.
  • Cystic fibrosis and ciliary dyskinesia. These are rare inherited genetic diseases in which the bronchi are unable to clear bacteria and the chronic infection results in bronchiectasis.
  • Allergic bronchopulmonary aspergillosis (ABPA). Patients with ABPA have developed an allergy to a fungus called Aspergillus. We all breathe in spores of Aspergillus everyday, and these inflame the lungs of patients who have the allergy to the fungus, damaging the bronchi and resulting in bronchiectasis.
  • Rheumatoid arthritis. Many patients with rheumatoid arthritis will also develop lung damage including bronchiectasis, probably as the inflammation caused by the rheumatoid arthritis also affects the lung.

The main symptom is recurrent chest infections, in which the patient develops a cough productive of green phlegm, and perhaps increased shortness of breath, fever, chest pains and malaise. In between infections, most patients will bring up some phlegm most days – small amounts of clear phlegm in milder cases, but patients with severe disease can produce large amounts of green and thick phlegm each day even when well. Patients with severe disease may also be short of breath when walking fast due to the underlying lung damage.

Bronchiectasis is usually diagnosed using a detailed X-ray of the lungs called a CT scan. A standard chest X ray is often normal or near normal in patients with bronchiectasis, and even when abnormal, the changes that are present may not be obviously due to bronchiectasis. Blood tests are required to test for some of the causes of bronchiectasis and it is also important to measure the lung size and function by a simple breathing test called spirometry.

Once bronchiectasis has developed, the damage cannot be reversed. However, in most patients, the disease either does not worsen or only slowly worsens with time, and the combination of regular physiotherapy to clear the chest and appropriate antibiotics control the symptoms reasonable well. It is vital that chest infections are treated quickly with effective antibiotics, eg. amoxicillin 500mg tds or coamoxiclav 625mg tds for at least 10 to 14 days. These prolonged courses of stronger antibiotics are important to prevent the chest infections recurring quickly. Some patients with frequent chest infections requiring antibiotics several times per year will need to start low dose antibiotics all the time to prevent infections. Characterising exactly what happens during an exacerbation of bronchiectasis and investigating the best long-term treatments are other areas of importance for research.

The need for fair access to new and precision medications is desperately needed for Bronchiectasis.

Living With Bronchiectasis

The most important considerations for patients with bronchiectasis are the following:

  • They need to perform regular lung clearance techniques to prevent phlegm and bacteria accumulating in the lungs. Except for patients with mild bronchiectasis, this will probably need to be done once or twice a day.
  • When an infection develops, the patient needs to start antibiotics as quickly as possible as this allows the infection to be brought under control more rapidly than if the antibiotics are delayed. Most patients should therefore have a reserve course of antibiotics at home. And it is important that the antibiotics are taken for 10 to 14 days to ensure the infection is well-controlled and less likely to return when the antibiotics are stopped.
  • To help prevent infections, the patients should have an annual vaccination against flu, and be vaccinated against pneumonia. And they should never smoke cigarettes.
  • Some patients may need to take inhalers, nebulisers or continual low dose antibiotics as well.

PCD

Primary Ciliary Dyskinesia (PCD) is an inherited, relatively rare condition associated with the abnormality of cilia (microscopic hairs that beat in the airways, sweeping secretions out of the respiratory tract). PCD may affect the lungs, nose, sinuses, ears and fertility. The condition involves recurrent infections in the nose, ears, sinuses and lungs.

If left untreated can lead to a form of lung damage known as ‘bronchiectasis’.

Visit PCD support Website

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