bronchiectasis

Dilation of the bronchial walls results in airflow obstruction and impaired clearance of secretions because the dilated areas interrupt normal air pressure of the bronchial tubes, causing sputum to pool inside the dilated areas instead of being pushed upward. The more the lungs experience infections, the more lung tissue and alveoli are damaged, and the more inelastic and dilated the bronchial tubes become, perpetuating the cycle of the disease.

Bronchiectasis was first described by René Laënnec in 1819 and later detailed by Sir William Osler in the late 1800s.

Diagnosis

The diagnosis of bronchiectasis is based on a clinical history of daily viscous sputum production and characteristic CT scan findings (such as multiple cysts near the bottom of the lung). However, bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent lung infections, a trademark symptom of bronchiectasis.

Early diagnosis of bronchiectasis is critical in slowing or stopping the disease's progression while the disease is still manageable. Often, the disease in its early stages is dismissed as bronchitis or asthma, but if a person gets frequent lung infections, there is a very good chance he or she could have bronchiectasis, and he or she should take care to prevent further infections.

Treatment

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

A classic bacterium that is seen in people with bronchiectasis is Pseudomonas aeruginosa, which is notoriously hard to eradicate. It is controversial whether to give those with bronchiectasis daily antibiotics to prevent infection from happening or whether to treat each time they become ill. Chronic tobacco use (smoking) can also lead to emphysema in 20% of smokers, which can lead to chronic bronchitis (productive cough for more than a total of 3 months over 2 consecutive years), which in turn can lead to scarring of the bronchi that develops into bronchiectasis. Adults can have inherited immunodeficiencies that present as recurrent lung infections that ultimately lead to bronchiectasis.

Prevention

Non-hereditary bronchiectasis often results from initial injury to the lungs, and thus prevention of injury such as pneumonia is critical, especially in children and immunodeficient individuals.