Bronchiectasis

Answer 1

Definition

Bronchiectasis is destruction and widening of the large airways.

• If the condition is present at birth, it is called congenital bronchiectasis.
• If it develops later in life, it is called acquired bronchiectasis.

Alternative Names

Acquired bronchiectasis; Congenital bronchiectasis

Causes, incidence, and risk factors

Bronchiectasis is often caused by recurrent inflammation or infection of the airways. It most often begins in childhood as a complication from infection or inhaling a foreign object.

Cystic fibrosiscauses about half of all bronchiectasis in the United States. Recurrent, severe lung infections (pneumonia, tuberculosis, fungal infections), abnormal lung defenses, and obstruction of the airways by a foreign body or tumor are some of the risk factors.

The condition can also be caused by routinely breathing in food particles while eating.

Symptoms

Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis.

They may include:

• Bluish skin color
• Breath odor
• Chronic coughwith large amounts of foul-smelling sputum
• Clubbing of fingers
• Coughing up blood
• Cough that gets worse when lying on one side
• Fatigue
• Paleness
• Shortness of breath that gets worse with exercise
• Weight loss
• Wheezing

Signs and tests

When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lobes of the lungs.

Tests may include:

• Aspergillosis precipitin test (to check for signs of the aspergillosis fungus)
• Chest x-ray
• Chest CT
• Sputum culture
• Complete blood count (CBC)
• PPD skin testto check for a prior tuberculosis infection
• Serum immunoglobulin electrophoresis
• Sweat test or other cystic fibrosis testing

Treatment

Treatment is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications.

Regular, daily drainage to remove bronchial secretions is a routine part of treatment. A respiratory therapist can show the patient coughing exercises that will help.

Antibiotics, bronchodilators, and expectorants are often prescribed for infections.

Surgery to resect the lung may be needed if medicine does not work or if the patient has massive bleeding.

Expectations (prognosis)

With treatment, most people can lead normal lives without major disability.

Complications

• Cor pulmonale
• Coughing up blood
• Low oxygen levels (in severe cases)
• Recurrent pneumonia

Calling your health care provider

Call your health care provider if:

• Chest pain or shortness of breath gets worse
• There is a change in color or amount of the phlegm you cough up, or if it is bloody
• Other symptoms get worse or do not improve with treatment

Prevention

The risk may be reduced if lung infections are promptly treated.

Childhood vaccinations and a yearly flu vaccine help reduce the chance of some infections. Avoiding upper respiratory infections, smoking, and pollution may also reduce your risk of infection.

References

Barker AF. Bronchiectasis, atelectasis, cysts, and localized lung disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 90.

Answer 2

Definition

Bronchiectasis is destruction and widening of the large airways.

• If the condition is present at birth, it is called congenital bronchiectasis.
• If it develops later in life, it is called acquired bronchiectasis.

Alternative Names

Acquired bronchiectasis; Congenital bronchiectasis

Causes, incidence, and risk factors

Bronchiectasis is often caused by recurrent inflammation or infection of the airways. It most often begins in childhood as a complication from infection or inhaling a foreign object.

Cystic fibrosiscauses about a third of all bronchiectasis cases in the United States. Certain genetic conditions can also cause bronchiectasis, including primary ciliary dyskinesia and immunodeficiency syndromes.

The condition can also be caused by routinely breathing in food particles while eating.

Symptoms

Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis.

They may include:

• Bluish skin color
• Breath odor
• Chronic coughwith large amounts of foul-smelling sputum
• Clubbing of fingers
• Coughing up blood
• Cough that gets worse when lying on one side
• Fatigue
• Paleness
• Shortness of breath that gets worse with exercise
• Weight loss
• Wheezing

Signs and tests

When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lobes of the lungs.

Tests may include:

• Aspergillosis precipitin test (to check for signs of the aspergillosis fungus)
• Alpha-1 antitrypsin blood test
• Chest x-ray
• Chest CT
• Sputum culture
• Complete blood count (CBC)
• Genetic testing, including sweat test for cystic fibrosis
• PPD skin testto check for a prior tuberculosis infection
• Serum immunoglobulin electrophoresis

Treatment

Treatment is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications.

Regular, daily drainage to remove bronchial secretions is a routine part of treatment. A respiratory therapist can show the patient coughing exercises that will help.

Antibiotics, bronchodilators, and expectorants are often prescribed for infections.

Surgery to resect the lung may be needed if medicine does not work or if the patient has massive bleeding.

Expectations (prognosis)

The outlook depends on the specific cause of the disease. With treatment, most people can lead normal lives without major disability.

Complications

• Cor pulmonale
• Coughing up blood
• Low oxygen levels (in severe cases)
• Recurrent pneumonia

Calling your health care provider

Call your health care provider if:

• Chest pain or shortness of breath gets worse
• There is a change in color or amount of the phlegm you cough up, or if it is bloody
• Other symptoms get worse or do not improve with treatment

Prevention

The risk may be reduced if lung infections are promptly treated.

Childhood vaccinations and a yearly flu vaccine help reduce the chance of some infections. Avoiding upper respiratory infections, smoking, and pollution may also reduce your risk of infection.

References

Iseman MD, Chan ED. Bronchiectasis. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 42.

Reviewed By

Review Date: 09/15/2010

David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA.