Bronchiectatic disease
Summary/Definition
Bronchiectatic disease is a condition in which the bronchi, which are the major airways in the lungs, are deformed or enlarged due to changes caused by previous severe inflammation of the airways, resulting in weakened or obstructed sputum production. Cilia, which are present in the bronchial tissue, move dust and bacteria trapped in the airways outward, clearing mucus from the bronchi. If the cilia are damaged due to infection or other reasons, the mucus is not properly expelled and becomes a breeding ground for bacteria. Chronic inflammation occurs and, over time, the bronchi begin to collapse and increase in size. The enlarged bronchi cannot return to their normal state. Causes of bronchiectasis include lung infections, airway obstruction, humoral immunity deficiency, rheumatism, primary ciliary dysfunction, etc.
Symptoms
The symptoms of bronchiectatic disease may gradually worsen over several months or years. Due to chronic bacterial infection, large amounts of dark green or yellow sputum with an unpleasant odor are produced, and most people complain of a chronic cough. As the condition worsens, the patient has difficulty breathing and chest pain. There may be changes in the phalanges of the fingers (called “drumsticks”) and nail plates as well. Hemoptysis is one of the most common symptoms of bronchiectatic disease. The degree of hemoptysis is usually mild but requires constant monitoring as it can progress to massive bleeding. Fever, weakness, or weight loss may occur.
Diagnostics
To diagnose bronchiectatic disease, the patient must undergo various diagnostic tests and provide a medical history. In the course of interviewing the patient, the doctor should ascertain how long ago the patient has had symptoms such as expectoration and difficulty breathing, as well as determine the severity of the symptoms present, assess the medical history, including the patient’s length of time as a smoker, and the general condition of the body. Clarify the patient’s current medical condition. The results of a computed tomography scan should show the extent of damage to the airway. An examination of the sputum produced by coughing will reveal the presence or absence of infection. Chest X-rays and lung function tests may also be ordered, and blood tests and other examinations may be performed to determine the current state of the lungs.
Treatment and course of the disease
In the treatment of bronchiectasis, early initiation of therapeutic procedures and prevention of secondary bacterial infections likely to develop in the affected bronchi are important. Medication treatment includes antibiotics, symptom relievers, and bronchodilators. Because complications may arise from bacterial infection, it is important during an exacerbation to treat according to the type of causative bacteria by using appropriate antibiotics and analyzing bacterial growth by culture test. In patients with airway hypersensitivity, bronchodilators can be used to alleviate airway obstruction and sputum expectoration. Non-pharmacological treatments include chest physiotherapy to promote effective sputum expectoration.
Complications
Complications include hemoptysis, recurrent pneumonia, chronic respiratory failure, pneumothorax, empyema, lung abscess, and other metastatic infections.
