Bronchiectasis is a permanent condition caused by dilatation of the medium sized bronchi, resulting in a sac-like formation. Walls to the bronchi are usually made of cartilage, elastic tissue and muscular element. In Bronchiectasis, this is destroyed and replaced by fibrous tissues. Causes include repeated inflammatory injury of the bronchi caused by infectious such as Tuberculosis and fungal infections. Lung abscess and pneumonia are other reasons.
Genetic causes such as primary ciliary dyskinesia or decreased mobility of small cilia in the bronchi. These cilia usually clear irritants in the airways. Kartagener’s syndrome is associated with bronchiectasis, sinusitis, and infertility. Exposure to toxic gasses such as ammonia can also lead to it.
Symptoms
Persistent cough with large amount of purulent secretions may be primary presentation. Patients may give a history of repeat pneumonias. Blood in the sputum, or hemopytsis may be seen. Massive bleeding can occur rarely because of damage and bleeding to enlarged bronchial blood vessels. Bad breathe, shortness of breath or wheezing in long standing cases, weight loss, anemia, and clubbing may also be seen.
Examination
On auscultation, rhonchi or crackles may be heard as well as wheezes. Chest x-ray in advanced cases may show 1-2 cm cysts. Air fluid levels may be seen in these cysts. This may the result of accumulation of pus. Bronchogram is a test where dye is given and it coats the bronchi and an x-ray is taken. This can lead to definitive diagnosis. This test has been replaced by ct scans. Bronchoscopy or direct visualization of the bronchi may determine the underlying cause.
Complications
Massive hemoptysis or bleeding from bronchial vessel can be seen. There can be the formation of lung abscesses and cause strain on the heart, causing right heart failure.
Treatment
There are 4 goals for treatment: 1) Elimination of causes- such as treatment of pneumonia or avoiding toxic causes. 2) Clearance of bronchial secretions by chest physiotherapy, hydration and mucolytics. 3) Control of infections by antibiotic usage. 4) Reversal of air flow obstruction by using medications such as bronchodilators.
Surgery may be needed in cases of localized bronchiectasis by removing part of the lung. In patients with extensive disease, oxygen therapy may be needed. In Patients who are disabled despite maximum therapy, lung transplantation is a therapeutic option.
Prevention
Patients who are more susceptible to bronchiectasis should have yearly Influenza vaccinations and Pneumococcal vaccinations every 5 years. |
