Bronchiectasis is a disease that is defined as a weakening in the walls of the bronchial tubes (the structures that transport air from the windpipe to the air sacs (the alveoli)). A consequence of the damage to the bronchial tube walls is the impairment of the normal ciliary function (the small hair-like structures that assure proper mucous flow in the bronchial tubes). The weakness in the walls results in inflammation and damage to the bronchial tubes, interfering with the body’s ability to clear mucous and bacteria.
Previous infection, such as pneumonia or bronchitis.
Cystic fibrosis, inflammatory bowel disease and various immune deficiencies
Abnormalities of esophageal function including acid reflux (GERD), hiatal hernia and swallowing disorders
An immune reaction or allergy to mold or fungus (allergic bronchopulmonary aspergillosis)
Infection of deformed bronchial tube by non-tuberculous mycobacteria (NTM) way worsen already existing bronchiectasis
Bronchiectasis affects both young and old. As noted by the National Institutes of Health, the prevalence of clinically apparent bronchiectasis increases with age, specifically increasing each decade after age 55. The prevalence increases by nearly 9 % per year among Medicare-age patients, affecting nearly 300 per 100,000 seniors. It occurs more often in women than men.
Left untreated, bronchiectasis may worsen with the continued accumulation of bacteria and inflammation, which will cause more damage. Early diagnosis of bronchiectasis will assure good respiratory health by keeping the distorted airways clean and free of bacteria, inflammation and infection. This “vicious cycle” worsens lung structure and function. Because there are no symptoms unique to this condition, early consideration to its diagnosis should occur in patients with frequent chest infections. Bronchiectasis can be diagnosed best by a “low-dose” CT scan of the chest without contrast injection. The specific diagnosis, extent of disease and clues as to the specific cause of the bronchiectasis can be learned from the CT scan, which takes several minutes to complete.
The emphasis of treatment is to keep mucous from collecting in those areas of the bronchial tubes that cannot effectively cleanse themselves. Proper hydration, over-the-counter mucous thinners and saline inhalation are effective in accomplishing these goals. Breathing exercises, assisted by hand-held devices to literally shake the mucous free, promote effective cleansing of distorted airways. Such maneuvers that take only minutes each day are self-administered and time-tested. Some patients benefit from more advanced forms of therapy under the care of a chest physical therapist.
Certainly, protection from respiratory infection is afforded by yearly influenza vaccination and periodic anti-Pneumococcal vaccination (Pneumovax).
The older practice of “rotating antibiotics” for the prevention of clinical infection has in most circumstances become unnecessary.
Regularly scheduled physician visits include a careful history review, physical examination and measurement of breathing function with pulmonary function testing. This is a good way of assuring that the above measures are effective and that bronchiectasis is not progressing. Repeated CT scans are not part of the routine management.
If you suspect that you are experiencing the symptoms of bronchiectasis, call Kamelhar-Teller Pulmonology today.
As there are no symptoms that are unique to bronchiectasis, the presence of ongoing cough, with or without mucous production, in a non-smoker should raise the possibility of the diagnosis and a CT scan of the chest should be scheduled. Mucous clearance devices in an asymptomatic patient can help prevent consequences later.
Call Kamelhar-Teller Pulmonology to start treatment of your bronchiectasis. Proper care today will minimize worsened conditions tomorrow.