What You Should Know About
Bronchiectasis
Bronchiectasis is a disease in which the bronchial tubes become chronically inflamed and dilated. In most cases, the cause of these changes is recurrent infections, including pneumonia in the same areas of the lung. Eventually, the bronchial tubes in the infected area or areas lose their shape and become sac-like. When that happens sputum collects and becomes infected. Therefore, patients with bronchiectasis have a chronic productive cough. Recurrent infections requiring antibiotics are common, as well as fatigue and low grade fever. Fortunately, bronchiectasis is less common now than it was in the past because of the availability of effective antibiotics.
A diagnosis of bronchiectais is based on a number of symptoms and signs:
- A medical history which indicates the presence of a chronic productive cough with recurrent infections and purulent sputum,
- Chest x rays which show a distinctive pattern of scarring, and
- A CT scan of the chest which shows the distinctive dilatation of the smaller bronchial tubes that is diagnostic of bronchiectasis.
Treatment
Because the basic defect in bronchiectasis is bronchial dilatation with collection of infected sputum, the goal of therapy is to enable the patient to expectorate the sputum to prevent it from becoming infected. To do this, the sputum must be moved from the periphery of the lung to the larger bronchi, where it can be coughed up. Traditionally, external percussion to the chest, and gravity drainage on a daily basis have been used to achieve this. More recently, a device called a flutter valve has been used to accomplish sputum removal. In addition, antibiotics must be given whenever the sputum becomes purulent and/or low-grade fever occurs. Sputum cultures are required periodically because drug resistance is common. For most patients, antibiotics are started only when the signs of acute infection are present. However, some patients require the use of antibiotics on a regular basis, perhaps for one week every month.
Finally, some patients develop bronchiectasis because of the aspiration of gastric acid from a condition called gastric esophageal reflux disease (GERD). Normally a valve between the esophagus and the stomach prevents gastric acid from backing up into the esophagus and, in extreme cases, into the lungs. When aspirated into the lungs, stomach acid can produce bronchiectais. Symptoms of cough and heartburn, which are worse at night when patients are recumbent, suggest a diagnosis of GERD.
Where to Get More Information
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