Bronchiectasis

Bronchiectasis is a lung condition in which some of the bronchi and bronchioles have lost their elasticity and have expanded and filled with fluid.

Causes

Most often, bronchiectasis follows pneumonia, whooping cough, tuberculosis, or another lung disease. (Fortunately, the use of antibiotics has reduced the number of cases due to lung infection.) Other causes include obstruction; clogging of the airways by the thick, mucous secretions of cystic fibrosis; and Kartagener's syndrome, a condition in which the cilia (the hairlike projections that line the bronchial walls and wave mucus, pus, and dirt upward) do not work properly.

Symptoms

Bronchiectasis is a chronic condition that persists for life. The individual almost always has some symptoms, which will worsen if an acute infection occurs. The most typical symptom is a chronic cough that produces thick, white or green sputum (discharge). The sputum may be foul-smelling and abundant and may also contain blood. The individual generally coughs up large amounts of sputum after changing position (for example, after rising from bed).

Diagnosis

The doctor, listening to the chest with a stethoscope, can hear abnormal sounds inside the lungs as the patient breathes. Chest X-rays or a computed tomography (CT) scan can be used to confirm the diagnosis. Chronic bronchitis must be ruled out as a cause, along with tuberculosis, certain fungal infections, a tumor, and the presence of an inhaled object that is lodged in a bronchi.

Treatment

Treatment of an active case of bronchiectasis includes fighting the infection with an antibiotic, such as penicillin or tetracycline, and eliminating the fluid with postural drainage. In the latter procedure, the patient lies face down in bed, with pillows elevating the hips, and a therapist strikes the back with cupped hands to loosen mucus.

The treatment, which can be taught to a family member, requires two to four ten-minute sessions a day. Inhaling warm mists may also help to moisten the thick mucus clogging the airways, so that it can be more easily expelled. The patient should avoid anything that can irritate the lungs, such as tobacco smoke, fumes, and dust.

In the relatively few cases in which the infection is confined to a small part of the lung and is progressing despite antibiotics and other forms of therapy, it may be best to surgically remove the affected portion of the lung.

Prevention

To help prevent progression of the disease, the patient should get immunized against the flu and pneumonia, avoid contact with anyone with a cold or cough if at all possible, and stop smoking. Getting prompt evaluation and treatment with antibiotics, when appropriate, can help to control new infections.