Table of Contents
Definition of Bronchiectasis
The dilation of a segment of BRONCHUS. Bronchiectasis may involve several bronchial branches and usually occurs deep within the lung, often in a lower lobe. Though bronchiectasis may be congenital (present at birth) or acquired (develop after birth), congenital bronchiectasis is rare and results when only the core structure of the LUNGS develops and existing bronchi dilate in reaction to the pressure of incoming air. Acquired bronchiectasis commonly develops with chronic lung INFLAMMATION such as results from CYSTIC FIBROSIS or repeated INFECTION (typically chronic BRONCHITIS).
Bronchiectasis represents permanent damage to lung tissue, often with accompanying PULMONARY FIBROSIS (scarring), and loss of lung function in the affected areas. Because of the lung’s segmented structure nonaffected segments and lobes of the lung continue to function normally, so the extent to which the bronchiectasis affects respiratory performance depends on the number of segments involved. However, bronchiectasis tends to be progressive.
Suspicion of bronchiectasis becomes valid with the existence of pulmonary conditions known to be predisposing, such as cystic fibrosis and chronic bronchitis. Bronchiectasis may follow recurrent PNEUMONIA, ASPIRATION pneumonia, childhood diseases such as PERTUSSIS (whooping COUGH) in children who have not received IMMUNIZATION, and toxic inhalation (such as smoke or chemical inhalation).
IMMUNODEFICIENCY disorders that increase the risk for pulmonary infections also raise the likelihood of bronchiectasis. Symptoms typically develop over months to years and commonly include
- persistent, productive cough more intense in the mornings and just before going to bed
- prodigious SPUTUM production
- HEMOPTYSIS (BLOOD in the sputum)
- wheezing (high-pitched, abnormal BREATH SOUNDS with exhalation)
The Diagnostic Path and Treatment
The diagnostic path includes chest X-rays and COMPUTED TOMOGRAPHY (CT) SCAN. The doctor may further desire BRONCHOALVEOLAR LAVAGE or bronchial biopsy (via BRONCHOSCOPY), sputum cultures, and blood tests. Treatment depends on the findings and may include ANTIBIOTIC MEDICATIONS to treat infections or CORTICOSTEROID MEDICATIONS to treat severe inflammation. Bronchodilator medications may help relax and open undamaged bronchi to improve lung capacity.
CHEST PERCUSSION AND POSTURAL DRAINAGE help loosen mucus so the normal mechanisms of the respiratory tract can move it out of the lungs. Rarely, surgery to remove a particularly eroded or chronically infected bronchial segment is necessary. Most people are able to manage bronchiectasis with regular medical evaluation and care (including prompt treatment at the earliest indication of infection). Regular physical activity and avoiding cigarette smoke are crucial to preserve remaining lung function.