Bronchiectasis
Bronchiectasis is a condition where the bronchi and bronchioles become permanently dilated. It can occur after chronic infection of the bronchi and bronchioles or it may be due to underlying congenital condition. Main organisms are Haemophilus influenza, streptococcus pneumonia, stahphilococcus aureus, pseudomonas aeruginosa.
Causes:
Congenital:
- Cystic fibrosis
- Young’s syndrome
- Primary ciliary dyskinesia
- Kartagener’s syndrome
Post infection:
- Measles
- Pertussis
- Bronchiolitis
- Pneumonia
- Tuberculosis
- HIV
Others:
- Bronchiol obstruction (tumour, foreign body)
- Allergic bronchopulmonary aspergillosis (ABPA)
- Hypogammaglobulinaemia
- Rheumatic arthritis
- Ulcerative colitis
- Idiopathic
Clinical features:
The symptoms of bronchiectasis may occur gradually and may takes months or years after the first event that cause bronchiectasis. Patient usually presented with persistent cough and copious purulent sputum. The cough may get worse when the patient lie on one side. Some patients may present with intermittent hemoptysis (cough up blood). Some people have fatigue and weight loss. On examination, the patients usually have finger clubbing, coarse inspiratory crepitations and wheeze. Other features can be bluish discoloration of lips and nails (cyanose) and patients may appear pale.
Complications:
Some known complications of bronchiectasis are:
- Recurrent lung infection (pneumonia)
- Cor pulmonale (right heart failure)
- Pleural effusion
- Pneumothorax
- Haemoptysis
- Cerebral abscess and amyloidosis
- Hypoxia (low oxygen level) in severe cases
Investigations:
- Full blood count to look for evidence of infection
- Sputum culture and sensitivity – took for responsible organism and sensitive antibiotics
- Chest X ray- look for cystic shadows and thickened bronchial walls (tramline and ring shadow)
- HRCT (High Resolution Computed Tomography) of the chest is a very useful test for diagnosis and to assess the extent and distribution of the disease
- Spirometry – frequently, obstructive pattern can be seen. This test also can assess reversibility of the disease.
- Bronchoscopy – Very useful test to locate the site of bleeding in the presence of hemoptysis or to look for any obstruction in the airways
- Other test that should be considered is serum immunoglobulins electropheresis, sweat test if any suspicion of cystic fibrosis, aspergillus precipitins test and skin prick test
Management:
Treatment is mainly at aiming to control the bronchial secretions and to control the infections, relieving the airway obstruction and prevent or delay the complications. With proper treatment, this patient may have normal lives with less disability.
- Postural drainage should be performed twice daily for symptomatic relief
- Chest physiotherapy will help sputum expectoration and mucous drainage
- Antibiotics will be prescribed in the evidence of infection according to bacterial sensitivities. In pseudomonas infection, patient will require either oral ciprofloxacin or IV antibiotics.
- Bronchodilators (e.g.: nebulized salbutamol) may give some relief to patient with underlying asthma, COPD, cystic fibrosis or ABPA.
- Corticosteroids (e.g.: tablet prednisolone or IV hydrocortisone) can be given depends on the severity of the symptom
- Surgery (lung resection) can be considered in few cases like localized disease, symptoms do not control with medications or to control massive bleeding due to severe hemoptysis.
Prevention:
- Treat lung infection
- Childhood vaccination – e.g.: yearly flu vaccination
- Avoid pollution
- Avoid upper respiratory tract infection
- Smoking cessation (and avoid being passive smoker)
If you are a patient, when do you seek for medical attention?
- If you develop symptom of respiratory distress – like shortness of breath, chest pain, cyanose
- You develop hemoptysis
- The medications do not longer work for you
- There is change on your sputum colour or amount
Reference:
- Murray Longmore et al. Oxford Handbook of Clinical Medicine. 7th edition. 2008. Oxford.
- http://www.nlm.nih.gov/medlineplus/ency/article/000144.htm
Tags: bronchiectasis, bronchodilator, cystic fibrosis, dyspnea, tuberculosis
Technorati Tags: bronchiectasis, bronchodilator, cystic fibrosis, dyspnea, tuberculosis
I have had this cough for a few months now. It was treated last year and then came back later. Sometimes it would go away for 2 weeks and then come back. After reading this post, I think it’s time to see my doctor again.