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Bronchiectasis

Overview

Bronchiectasis is a disease that damages the walls of the large airways, or bronchial tubes, of the lungs. Inflammation due to infection or other causes destroys the smooth muscles that allow the bronchial tubes to be elastic and prevents secretions that are normally made by lung tissue to be cleared. Bronchiectasis is a form of chronic obstructive pulmonary disease (COPD) that also includes emphysema and chronic bronchitis. Bronchiectasis can be present by itself, but usually more than one of the prior mentioned components of COPD coexist in the same person.

Symptoms

Bronchiectasis develops over a prolonged period of time. Common symptoms include:

  • Recurrent cough and sputum production : Most often the mucus is clear, but there may be traces of blood due to bronchial wall injury. The mucus is also green or yellow if there is infection.
  • Shortness of breath and fatigue : Breathlessness and tiredness develop as lung function decreases. Wheezing may or may not be present.

Causes

Bronchiectasis is caused by damage to the larger airway walls. The muscles and elastic tissue layers that allow normal bronchial tubes to contract are destroyed. This leads to the disability of the lung to move and clear secretions that are produced in the lung causing infections like pneumonia and bronchitis.

There are three primary types of bronchiectasis, namely:

  • Cylindrical bronchiectasis : This is the mildest form and indicates loss of the normal tapering of the airways. It is discovered on CT scans of the chest.
  • Saccular bronchiectasis : This is more severe and causes further distortion of the airway wall.
  • Cystic bronchiectasis : This is the most severe form of bronchiectasis, but is the least common form.

Bronchiectasis also may be congenital or acquired. The causes for each are listed below.

The congenital causes of bronchiectasis are:

  • Cystic fibrosis
  • Kartagener syndrome
  • Young's syndrome
  • Alpha-1-antitrypsin deficiency

The acquired causes of bronchiectasis are:

  • Recurrent infection
  • Aspiration of foreign bodies or other materials
  • Inhalation of toxic gases like ammonia
  • Alcohol and drug abuse
  • Tuberculosis
  • Inflammatory bowel disease (ulcerative colitis, Crohn's disease)

Risk Factors

The most relevant risk factors for Bronchiectasis are:

  • Serious infection
  • Foreign body aspiration
  • Long-standing cystic fibrosis
  • Chronic obstructive lung disease

Complications

Bronchiectasis causes disability of the lungs to mobilize secretions, which lead to recurrent infection, difficulty breathing, and increased sputum production. This further decreases air entry into the lungs causing shortness of breath. The decreased oxygen level in the lungs further leads to constriction of the pulmonary arteries resulting in pulmonary hypertension. These increased pressures force the heart to work harder causing thickening of the right ventricle leading to a condition called cor pulmonale.

Bronchiectasis may result in hemoptysis (coughing up blood). Hospitalization may be necessary for pneumonia, respiratory failure, massive hemoptysis, and heart failure. The most common causes of death are heart failure and respiratory failure.