Bronchiectasis - Symptoms, Risk factors and Treatment

Bronchiectasis is a condition in which the bronchi of the lungs become permanently enlarged, causing cough with a lot of mucus.

What are the bronchi?

The bronchi are cylindrical structures that arise from the trachea- also known as the windpipe. There are two bronchi, one on the right and one on the left, and supply the respective lungs. The bronchi divide into bronchioles which divide further into tiny spaces called the alveoli. All this passage constitutes the airway and is responsible for the passage of air into the lungs. This airway should be clear for proper passage of air into the lungs and thereby, good oxygen delivery.

What causes bronchiectasis?

Cystic fibrosis:

Bronchiectasis can be involved with a disease called cystic fibrosis- a genetic disorder in which there is a mutation in a type of protein that adversely affects the lungs and other organs such as the pancreas, kidneys, liver, and intestines. Lungs are affected due to airway clogging due to excess mucus buildup.

Respiratory infections:

Bronchiectasis can be due to different infections of the lungs such as:

• Influenza caused by Haemophilus influenzae
• Tuberculosis caused by mycobacterium tuberculosis 
• Atypical pneumonia due to streptococcus, chlamydia, legionella, etc.

Autoimmune diseases:

Bronchiectasis can also be linked with different autoimmune diseases. In autoimmune diseases, your body's immune system misidentifies its own cells and starts to cause damage to them. Autoimmune diseases that may be associated with bronchiectasis include:

• Rheumatoid arthritis
• Systemic lupus erythematosus (SLE)
• Ulcerative colitis
• Crohn’s disease
• Sjögren syndrome

Lowered immunity

Any condition that causes the immune system to be suppressed causes different bacteria and viruses to infect an individual, as the immune system is responsible for fighting off different infections. Conditions like AIDS, cancer chemotherapy, diabetes, etc. can predispose a person to catch different infections causing repeated cycles of inflammation, giving rise to bronchitis.

Hypersensitivity:

Hypersensitivity to different gases and dust can be associated with bronchiectasis along with asthma. One such disease with hypersensitivity is aspergillosis- a condition caused by hypersensitivity to a fungus called  Aspergillus fumigatus.

Airway obstruction:

If the airway is obstructed, inflammation occurs. Therefore, bronchiectasis can occur in airway obstruction. The airways can be obstructed due to:

• Tumors
• Foreign body 

Aspiration:

Aspiration of gastric contents due to GERD or vomit or different fluids and food can cause bronchiectasis as such substances irritate the lungs and cause inflammation.

Genetic causes:

Bronchiectasis can be due to different genetic conditions such as primary ciliary dyskinesia or Alpha-1 antitrypsin deficiency.

How bronchiectasis occurs?

Bronchiectasis occurs as a result of chronic inflammation due to irritation and injury by the above-mentioned causes. Inflammation is the body’s attempt to repair the damage, but chronic inflammation destroys lung tissue and architecture. It causes enlargement and dilation of the airways and an inability to clear up secretions of the lungs. Due to this, mucus starts clogging in the airways, causing breathing problems.

Symptoms of bronchiectasis:

The signs and symptoms of bronchiectasis include:

• Long-standing cough
• Cough with lots of mucus
• Cough along with blood
• Whistling sound (wheezing) when breathing
• Breathlessness
• Chest pain
• Weight loss
• Malaise
• Spoon shaped nails (clubbing)
• Increased infections of the lungs

Diagnosis of bronchiectasis:

Bronchiectasis can be diagnosed by the following:

History and physical exam: Your doctor may ask questions related to exposure to different substances, history of any respiratory infections, and questions related to cough, for how long it has been occurring and how much mucus does the cough contain, etc. Other than this, your doctor may perform a physical examination for diagnosing bronchiectasis.

Lung function test: Your doctor may suggest a lung function test to evaluate how well your lungs are working.

For confirmation of the diagnosis, your doctor may suggest:

• Chest X-ray
• CT scan
• Sputum cultures to diagnose any infections

Bronchoscopy- a test in which the doctor sees the inside of the bronchus through a tube with a camera.

Treatment of bronchiectasis:

The treatment of bronchiectasis may involve:

Bronchiectasis cannot be cured. However, with medications, it can be managed. The treatment options may include:

Antibiotics: If a bacterial infection is diagnosed, your doctor may prescribe antibiotics to clear up the infection.

Steroid medications: These are drugs to reduce inflammation which is also thought to be the cause of bronchiectasis.

Expectorants: These are medications that help you cough up mucus and clear up the clogged airways.

Airway clearance: Your doctor may suggest different strategies to clear up the airways, such as physical therapy or positive expiratory pressure (PEP) devices, etc.

Surgery: To manage bronchiectasis, segments of the lungs affected with bronchiectasis may be removed surgically. Moreover, if bronchiectasis is due to an obstruction, surgery can be done to remove the obstruction.

Lung transplant: Lung transplant may be suggested as a final answer if the disease becomes very advanced.

Complications of bronchiectasis:

The complications of bronchiectasis include:

Recurrent lung infections: 

Bronchiectasis can make a person more vulnerable to different respiratory tract infections, requiring frequent hospitalizations.

Empyema:

In this condition, pus accumulates in the pleural space. This is mostly due to a bacterial infection. It may make it harder for you to breathe due to pressure. Moreover, this infection may spread to other organs.

Lung abscesses: It is a condition in which a pocket of pus forms in the lungs.

Respiratory failure and hypoxemia: Due to poor gas exchange in bronchiectasis, lung failure and hypoxemia can occur causing low levels of oxygen in the blood and to different organs, having its own complications such as loss of consciousness or coma.

Right-sided heart failure: The right side of the heart supplies blood to the pulmonary artery. Due to poor lung function, pulmonary hypertension takes place, and the pressure in the right side of the heart increases and it has to work harder. It causes a progressive increase in the size of the right side of the heart (cor pulmonale ) and a reduction in its function referred to as heart failure. 

Conclusion

Bronchiectasis is a condition that affects the lungs. It cannot be cured. But with proper treatment, it can be managed, and the quality of life can be improved. If you notice any signs and symptoms of bronchiectasis, consult your doctor to get treatment as soon as possible.