What is Bronchiectasis?

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ronchiectasis is a disease of the lungs that causes damaged airways to permanently dilate. This leads mucus build up in the patient’s lungs, making it harder to breathe and creating a viable environment for bacteria and infections. Bronchiectasis often happens after repeated damage to the airways and lungs, which may happen from chronic infections or autoimmune diseases. A fairly uncommon disease, there are about 139 cases per 100,000 adults in the United States, and it tends to affect women more often than it does men. Bronchiectasis is a chronic condition, meaning that there is no cure for it, however, there are treatments available that can help patients control and manage their symptoms. Bronchiectasis clinical trials are ongoing in the United States and around the world, with a variety of treatments being tested.

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What Causes Bronchiectasis?

Bronchiectasis can be congenital (meaning that the patient already had it before being born), or caused by lifestyle and environmental factors. Congenital bronchiectasis happens when the lungs develop abnormally in utero. With acquired, or environmental bronchiectasis, damages to the airways can begin during childhood; however, a person might not develop any symptoms until many years later. Some of the most common causes of bronchiectasis are:

Lung Infections

Lung infections can cause severe damage to the walls of the airways, leading to bronchiectasis. Some of these lung infections include whooping cough, severe pneumonia, and tuberculosis.

Chronic Obstructive Pulmonary Diseases (COPD)

COPD is an umbrella term that doctors use to describe chronic bronchitis, emphysema, and chronic asthma. Patients who have lived with COPD with many years often develop bronchiectasis.

Autoimmune Diseases

Autoimmune diseases such as lupus and rheumatoid arthritis often lead to bronchiectasis because they can cause inflammation and damage to the lungs and airways.

How is Bronchiectasis Diagnosed?

When a patient has a persistent cough with large quantities of phlegm (mucus), the doctor may suspect bronchiectasis and order different types of tests. These tests include:

A Sputum Sample

The doctor collects a small amount of sputum (spit) to check for any viruses, bacteria or other microorganisms. A doctor or technician may take a sputum sample from expectoration (coughing), use a tube to suction some of the sputum out, or they may induce coughing and sputum production with a saline solution.

Blood Tests

There are many conditions that cause bronchiectasis. When health care providers suspect bronchiectasis, they might order blood tests to check if there are any underlying conditions such as rheumatoid arthritis and Crohn’s disease present.

Imaging Tests

The doctor may decide to perform some imaging tests such as X rays, CT or CAT scans to assess the anatomy of the lung and look for visible damages or thickening in the airways.

Pulmonary Functioning Tests

These tests are performed to determine if the lungs are functioning properly. During a pulmonary functioning test the doctor may have the patient breath in and out a tube with neutral and maximum effort to measure the volume of the lungs.

Treating Bronchiectasis

While most patients with bronchiectasis have chronic symptoms, a particularly severe episode is called an exacerbation. During an exacerbation, the patient experiences at least three of the following symptoms:

  • Increase in sputum volume
  • More breathing difficulty than usual
  • Change in sputum color
  • Weakness or fatigue
  • Coughing up blood (hemoptysis)
  • Increased coughing

Though there is no cure for bronchiectasis, treatments exist to alleviate symptoms and prevent exacerbations. Some of the treatments (including some clinical research) to prevent exacerbations include:

  • Vaccines: doctors may recommend patients to get pneumococcal and flu vaccines in order to protect the lungs against the virus. Any virus that attacks or affects the airways can be extremely dangerous to a patient with bronchiectasis.
  • Bronchodilators: these are medications that open the airways to allow breathing. Some bronchodilators that might be prescribed for patients with bronchiectasis include albuterol, formoterol, and levalbuterol.
  • Antibiotics: patients with bronchiectasis experience repeated lung infections. A one to two-week antibiotic cycle is the treatment of choice to for these infections. Doctors also prescribe antibiotics during an exacerbation episode.
  • Oxygen therapy: can be prescribed during exacerbations or in severe cases of bronchiectasis in order to increase blood oxygen levels.
  • Surgery: a doctor may recommend surgery when the bronchiectasis is limited to one part of the airway or if severe bleeding occurs. During surgery, the doctor removes the damaged or affected area of the airway, or in severe cases, the patient may receive a lung transplant.

Bronchiectasis Clinical Trials

ClinicalTrials.gov: Recruiting Studies | Bronchiectasis | Last update posted in the last 300 days Studies found on ClinicalTrials.gov by a search of: Recruiting Studies | Bronchiectasis | Last update posted in the last 300 days

Lifestyle Changes
  • Learn to recognize what might trigger an exacerbation event so you are always prepared and able to act fast.
  • Try to quit smoking if you smoke. Smoking affects your lungs and can cause further damage.
  • Avoid strong smells and lung irritants such as dust, smoke, and fumes.
  • If you are feeling overwhelmed, talk to someone. Talking about your feelings, fears, and concerns with people who are going through the same as you can be very helpful. There are several online and in-person support groups for patients with bronchiectasis.
Tips For Friends and Family
  • Make sure your loved one seeks treatment for his/her bronchiectasis, especially during a severe exacerbation.
  • Be patient with your loved one, chronic lung conditions can be very frightening and uncomfortable. Offer to help whenever you can and be understanding of their condition.
  • Try to keep the environment around your loved one clean and free of dust and other contaminants that might make their condition worse.
  • Patients with chronic lung diseases are more prone to emotional problems such as anxiety and depression. If you think your loved one might be struggling with his/her condition reach out and encourage them to seek expert help.

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Sources
  1. https://www.bmj.com/rapid-response/2011/11/01/role-pneumococcal-and-influenza-vaccination-management-bronchiectasis
  2. https://www.nhlbi.nih.gov/health-topics/bronchiectasis
  3. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/bronchiectasis/diagnosing-and-treating.html