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Bronchiectasis : Types, Causes, Treatment & Diagnosis

Bronchiectasis

The inflammation of bronchi is called bronchiectasis. Person who has Sputum, productive cough for prolonged period due to some chronic lung’s infection is said to have bronchiectasis. People often confuse between bronchiectasis and asthma the difference is mainly the type of cough a patient presents with. If its dry cough (in case of asthma) or productive cough (in case of bronchiectasis). The walls of bronchi thicken in this condition. It’s a chronic condition that persist in patient for years.

Pathogenesis

Bronchiectasis is an obstructive lungs disease. That means that it affects lungs by obstructing the air passageway in lungs. The pathophysiology of bronchiectasis can be explained with the help of three mechanisms, all of these 3 mechanisms can result in pathology,

  • Peribranchial fibrosis

According to this theory, bronchiectasis result from damages tissues surrounding bronchi. The tissues around bronchi fibrosed (scared) after an injury to tissues and the inflammation that occurred surrounding tissue also effected bronchi.

  • Recurrent infections

The most common and widely accepted theory is that bronchiectasis developed due to multiple recurrent infections in lungs (or other place but travel to lungs ultimately).

  • Airway obstruction

According to this mechanism, bronchiectasis is the due to the obstruction in airway that result in trapping or air and moisture in lungs that caused inflammation of lungs and hence bronchiectasis.
All of the above written mechanism result in permanent inflammation (thickening and dilatation of bronchial walls) and cause excessive mucus production due to enlargement of mucus secreting glands along with the dilatation of airways and this justifies large amount of sputum production in cough.

Bronchiectasis

  • Types

Bronchiectasis is of three types depending on the shape of bronchi after inflammation started,

  • Cylindrical bronchiectasis

Bronchi become cylindrical and enlarges.

  • Saccular bronchiectasis

Bronchi dilates and form cysts.

  • Varicose bronchiectasis

Bronchi become irregular and contain sites of constrictions and dilatations.
Out of all types of bronchiectasis the most common site of bronchiectasis is proximal part of right middle lobe of a lung.

Causes

The major causes of bronchiectasis include,
Cystic fibrosis (an autoimmune disease of lungs), multiple recurrent infections of air passageway (specially childhood infection), immunodeficiency (innate or due to any medicine such as cancer treatment), ABPA (allergic bronchopulmonary aspergillosis), cancerous mucous producing cell activity, connective tissue diseases or any other lung obstructive disease, etc.

Bronchiectasis

Symptoms

Signs and symptoms associated with bronchiectasis are,
Breathlessness, difficulty breathing, Coughing (chronic productive cough which produce sputum of yellow or green colour), haemoptysis (bleeding in cough), fever, chills, fatigue, restless, chest pain (due to pleura), wheezing sound while breathing, weight loss, ischemia due to low oxygen saturation/concentration of body, etc.

complications

complication of a disease means that a person suffering with disease is more vulnerable to other associated diseases. These are the negative effects of disease which occur when patient neglect their symptoms and do not take proper medications. There are many complications of bronchiectasis. Complications of bronchiectasis includes,
pneumonia, empyema, septicaemia, respiratory failure, right side heart failure (cor pulmonale), sec. amyloidosis, nephrotic syndrome, lung abscess (pus), kidney disease (nephrotic syndrome), pneumothorax (air in pleura), chronic infections, lung cancer (as studies have shown bronchiectasis is associated with lung cancer, etc.
the complications of bronchiectasis show that it can lead to irreversible organs damage if not treated in early stages of condition.

tests for diagnosis

to investigate bronchiectasis following test are done,

  • X ray

Colonies of microbes are easily visible in chest x rays. The vegetation present in lungs appear lighter in colour and denser.

  • CT scan

High resolution Computed tomography is more precise imaging technique of investigation. The chest CT scan detect precise location and shows how big the vegetation is. It not only checks lungs but also detect any associated pathology of heart.

  • LFT

Lungs functioning tests are used to measure lung capacities and volumes. Disturbed Ventilatory pattern and obstruction in air passageway may represent bronchiectasis.

  • sputum samples/ cultures

the sputum culture test is also carried out to check for the causative agent in the pathogenesis. This test also differentiates bronchiectasis from TB (acid fast bacilli present in culture in case of TB).

Treatment

Unfortunately, bronchiectasis has no cure yet. So, Treatment of bronchiectasis includes loading doses of antibiotics, along with pain killers, cough syrups, muscle relaxant, hydration (keeping body and throat hydrated help the patient breath easily) chest physiotherapy (help the patient to drain the sputum and breath smoothly).

Research

Studies have showed that the chance of developing bronchiectasis increases with advancing age due to progressive immunodeficiencies in olds. Demographic studies have shown that bronchiectasis effect both people of developed and underdeveloped countries. It is on the verge of becoming an epidemic. Epidemiologists claim that 300 to 500 people in every 100,000 people around the world which is extremely high.

Bronchiectasis

Conclusion

Proper hygienic measures, and early medication is the way to treat patient. Bronchiectasis can be fatal when its attack is severe. It should be considered seriously and medical care provider should be consulted.

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