Bronchioectasis - Irreversitble Lung Disease

Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree. It is classified as an obstructive lung disease, along with emphysema, bronchitis and cystic fibrosis. Asthmatic bronchitis symptoms are similar. Brochiectasis is the destruction and widening of the large airway. This disease can be present at birth and is called congenital brochiectasis or it develops later in life making it an acquired brochiectasis. Acquired Immune Deficiency Syndrome (AIDS) is one of the major causes of brochiectasis. Kartagener syndrome which affects the ability of the cilia in the lungs, aids in the development of the disease. Another common genetic cause is cystic fibrosis where a small number of people will develop severe localized brochiectasis. Young’s syndrome which is similar to cystic fibrosis is thought to contribute to the development of this disease.

Basically this is due to the occurrence of chronic, pulmonary infections. Another less common congenital cause is primary immunodeficiencies due to a weakened immune system that can’t fight against the infection. This would also hold true for someone with a weakened immune system due to chemotherapy which can make cancer patients and patients with autoimmune diseases more susceptible to the disease.

The primary cause of anyone acquiring this disease is due to tuberculosis. It is a particular common disease for children with HIV as well. This disease predisposes patients to a variety of pulmonary ailments, such as pneumonia and other opportunistic infections. Bronchiectasis can sometimes be an unusual complication of inflammatory bowel diseases, such as ulcerative colitis and it can occur in Crohn’s disease as well. More recent evidence shows an increase in this disease for rheumatoid arthritis patients that smoke with one study showing a 10 fold increase for this individual. They still can’t prove that cigarette smoking is a primary cause of this disease.

Environmental exposures are also causes and include respiration infections, obstructions, inhalation and aspiration of ammonia and other toxin gases, pulmonary aspiration, alcoholism, heroin use, and various allergies. Another cause is Allergic bronchopulmonary aspergillosis (ABPA) which is a condition characterized by an exaggerated response of the immune system to the fungus Aspergillus occurring most often in patients with asthma or cystic fibrosis.

Symptoms of brochiectasis often develop gradually and may occur months or even years after the causative event.

They may include:

• Bluish skin color
• Breath odor
• Chronic cough with 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
• Chronic cough coughing up thick, white, or green sputum.
  

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

Regular Nebulizer treatments are used to clear the airway. A respiratory therapist can show the patient coughing exercising that will help. Inhaled steroid therapy is consistently adhered to and can reduce sputum production and decrease airway constriction over a period of time, plus it helps to prevent progression of the disease. Inhalers, such as albuterol, fluticasone (Flovent) and Atrovent may help reduce the likelihood of infections by clearing the airway and reducing inflammation. Antibiotics, bronchodilators and expectorants are often prescribed. Surgery to resect the lung may be needed if medicine does not work or if the patient has massive bleeding.

Although not approved for use in the USA, Mannitol dry inhalation powder under the name Bronchitol has been granted “orphan drug” status by the FDA for use in patients with brochiectasis and with cystic fibrosis. These patients tend to be on antibiotics every couple of months as mucous gets caught in the pockets of the lung tissue caused by the disease and the patient is unable to cough them up effectively

Thyme is an excellent herb for conditions of the lung as its properties have the ability to break down mucous which makes it ideal for bronchitis and asthma. It is considered an expectorant. While it created a productive cough is also has the ability to reduce bronchial spasm. Thyme is anti-microbial it reduces the severity of the symptoms of respiratory infections and kills the micro-organism causing the infection. It is largely used as aromatic oil called Thyme Oil. This information is published by the British Herbal Medicine Association. There are other types of herbal medicines that treat lung diseases but I would recommend talking with your doctor and someone that is well experienced in herbal medicine. I am not recommending any treatments.

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

There are several tests the doctor does to diagnosis this condition. The doctor may hear small clicking, bubbling, wheezing, rattling or other sounds in the lower lobes of the lungs with a stethoscope.

Tests may include:

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

The prognosis is better than you might think and most people can live a fairly normal life with some disability. To prevent complications lung infections must be treated promptly. Childhood vaccinations and an annual flu shot will help the chance of infection. Avoid smoke and pollution as much as possible.

There are possible severe complications, such as cor pulmonale which is basically right sided hear failure, coughing up blood, low oxygen levels in severe cases and recurrent pneumonia.

Certainly call the doctor is the patient has chest pain or their shortness of breath gets worse; if there is a change in the color of phlegm coughed up or if it is bloody; if other symptoms get worse or do not improve with treatment. Bronchiectasis is a serious, irreversible lung disease even though close monitoring by your physician will keep you in better health. It is important to contact your doctor for any signs of infection or difficulty breathing.

The copyright to this article is owned by Pamela Oglesby. Permission to republish this article in print or online must be granted by the author in writing.