Bronchiectasis – treatment, symptoms, causes and prognosis

Proven content

Bronchiectasis is characterized by a ballooning or cylindrical segmental widening of the bronchial tubes due to an inborn weakening of the wall’s elasticity or as a consequence of chronic bronchitis. Some people may not be aware of the disease for a long time as it sometimes produces no symptoms.

What is bronchiectasis?

Bronchiectasis is a condition that consists in abnormal widening of the walls of the bronchi (baggy, cylindrical) caused by damage to their structure. It may be related to chronic inflammation in the bronchial wall combined with necrotic changes. Normally the airways produce a small amount of mucus that is designed to stop microorganisms from entering the lungs. Then the mucus containing pathogenic microorganisms is carried to the throat and removed from the respiratory tract to prevent infection. However, there may be cases where mucus builds up in the airways, leading to the multiplication of bacteria and, consequently, the development of inflammation and dilatation of the bronchial walls.

Detection of bronchiectasis may be accidental during specialized examinations for other reasons, such as bronchography, i.e. contrast radiographic examination of the lumen of the bronchial tree. At that time, they may already cause periodic haemoptysis due to varicose veins in their vicinity.

With time, however, usually after inflammation in the airways, the so far dry bronchiectasis becomes re-infected. Then there is the formation of chronic inflammation, the production of a very abundant secretion and its retention in these dilatations. The discharge does not enter the bronchus until almost the entire “dilated” space is filled with it. Hence, infected bronchiectasis can cause chronic, generally purulent, bronchitis. Chronic cough and the associated pressure variability in the airways burden the circulation. These kinds of changes are irreversible. As a consequence, they usually lead to the so-called pulmonary heart syndrome.

The structure of the bronchi

The bronchi are made of bifurcating tubes whose function is to deliver air to the lungs. The structure of the bronchi consists of cartilage tissue, connective tissue and the muscle membrane. The bronchial lumen, in turn, is lined with a mucosa. The structure of the bronchi resembles that of the trachea.

Bronchiectasis – the causes of the disease

The causes of bronchiectasis can be divided into congenital and acquired. In addition, two factors play a significant role in the mechanism of disease formation: long-term obstruction of the lumen and inflammatory changes located peripherally from the obstructed site.

Congenital causes

1. Ailments with improper slime cleaning.

2. Cystic fibrosis.

3. Abnormal structure of the cartilages of the bronchial wall and trachea.

4. Immunodeficiency and diseases related to it (eg AIDS).

5. Congenital lung defects (eg hypoplasia).

6. Young’s syndrome.

7. Deficiencies of alpha1-antitrypsin.

8. Primary ciliary dyskinesia (Kartagener syndrome).

Acquired causes

1. Thermal damage.

2. Diseases causing pulmonary fibrosis.

3. Bacterial and viral infections.

4. Pylica.

5. Sarcoidosis.

6. Radiation damage.

7. Bronchoconstriction due to the presence of a foreign body or tumor.

8. Inhalation of toxic substances (gases, dust).

9. A condition in the form of gastroesophageal reflux, which causes the passage of food contents to the respiratory tract.

10. Allergic bronchopulmonary aspergillosis.

11. Long-term cigarette smoking.

12. Asthma.

Bronchiectasis – Symptoms

The most common symptoms of bronchiectasis are:

1. chronic cough that often occurs with the production of purulent (yellow) sputum,
2. bad breath,
3. feeling short of breath (especially when doing some physical activity),
4. wheezing
5. recurrent respiratory tract infections associated with fever, fatigue and weight loss
6. recurrent otitis media, infertility, inflammation of the paranasal sinuses and the opposite position of the viscera – occur in the case of primary ciliary dyskinesia,
7. pain in the chest,
8. exercise intolerance,
9. hemoptysis (as a result of damage to the mucosa),
10. stick fingers.

How do we recognize a bronchial exacerbation?

Medical history with the patient plays an important role in the diagnosis of bronchiectasis. It concerns a history of respiratory diseases. Symptoms in the form of chronic cough, sputum production, wheezing and bronchial murmurs reported by the patient – in physical examination quite clearly indicate some abnormalities in the respiratory tract. However, a verification of suspicions is needed, in which they are helpful imaging tests in the form of computed tomography and chest X-ray examinations.

In patients with extensive bronchiectasis, X-ray shows darker areas caused by nephritis and finger-shaped shadings that indicate dilated and mucus-filled portions of the bronchi. Low visibility of the lungs during the examination may suggest inflammation or fibrosis. On the other hand, computed tomography (high resolution) can clearly confirm the suspicion of bronchiectasis. The examination shows the widening of the lumen of the bronchi and thickening of their walls.

Another test performed in the diagnosis of bronchiectasis is bronchoskopia, which is performed in patients with concomitant haemoptysis. Its purpose is to exclude endobronchial changes, including cancer. In patients with recurrent respiratory infections, bacteriological examination of the discharge is necessary.

important: all patients should undergo spirometry at least once a year! It helps detect obstructive disorders.

Bronchiectasis – Treatment

There is no causal treatment for bronchiectasis. In conservative treatment, however, special attention is paid to the purification of the bronchial tree secretion and the elimination of respiratory tract infections.

Pulmonary rehabilitation is very important, the purpose of which is to remove the secretions remaining in the bronchi. Techniques such as postural drainage (specific position of the patient that facilitates the outflow of secretions located deep in the small bronchioles), the technique of forced exhalation (breathing through “pursed lips”), as well as the use of special devices that generate positive pressure when exhaling.

In the case of bronchiectasis, only secondary bronchial infections and usually long-term, persistently recurring inflammatory reactions should be treated. Such complications, however, are resistant and not amenable to treatment, because the drug has difficulty getting to the place where the purulent discharge remains.

1. Climatic and sanatorium treatment sometimes gives favorable results.
2. You can also use inhalations with drugs that dilate the bronchial tubes or relax their thick secretions, thus facilitating its expectoration.
3. You can also take bacteriostatic or bactericidal preparations in a similar way, i.e. by inhalation.
4. In the treatment of acute infections, empiric antibiotics (amoxicillin with clavulanic acid and clarithromycin) are used.
5. In unbearable, persistent and limited bronchiectasis, surgical treatment can be considered, which consists in cutting out those parts of the lung tissue in which the dilatations are located.

Smoking cigarettes adversely affects the treatment and contributes to the persistence of chronic catarrh. All other chronic and recurrent inflammation of the airways have a similar effect.

Bronchiectasis – Prevention

In the case of bronchiectasis and secondary bronchial infections, you should:

1. quit smoking – it is a factor contributing to the increased secretion of mucus in the bronchi and their chronic catarrh,
2. remove moisture and fungus from the apartments, because these are factors contributing to chronic bronchitis and secondary infections, not only bacterial, but also fungal,
3. carry out prophylaxis against bronchitis and fight it consistently and effectively.