Pulmonary - Critical Care Associates
of East Texas

Jeffrey M. Shea, M.D., F.C.C.P.
                              Catherine M. Martinez, M.D.

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This is a disease that is caused by recurrent inflammation or infection of the airways.  It damages the muscle and elastic tissue of the airways in the lungs. As a result of the damaged bronchial wall there can be permanent dilation of the airways. This dilation can be a uniform enlargement or irregular and result in the formation of pouches. These pouches of the airways are susceptible to infection. When small infections accumulate, you may become very ill.

You can be born with it or you can acquire it as an adult or child through one or more of the following ways:

1. Accidental inhalation of a foreign object into your lungs, causing inflammation.
2. Obstruction of the airways due to a tumor.
3. Gastroesophageal reflux (GERD, heartburn) is when the valve or sphincter connecting your esophagus and stomach is relaxed; this allows a backward flow of stomach contents to enter you lungs and irritate the airways.
4. Having another chronic lung condition, such as cystic fibrosis, allergic aspergillosis, tuberculosis, whooping cough (pertussis) or an immune deficiency disease or repeated episodes of flu and pneumonia.
5. Kartagener’s Syndrome is a rare genetic disease that comprises chronic sinusitis, situs inversus (reversal of body organs so that what is supposed to be on the right side of the body is now on the left),  chronic saccular bronchiectasis, and loss of the ability to clear mucus.

There is injury to the walls of the airways by recurrent inflammation. The immune defenses of the respiratory tract weaken and lose ability to clear mucus, therefore making the airways susceptible to infections. Having repeated lung infections causes permanent damage to the elastic tissue within the bronchial wall and what finally develops is chronic weakness and pouching of the airway walls.

With bronchiectasis you have a recurring cough with mucus. The mucus may be discolored and foul smelling, sometimes containing blood. You may also experience fatigue, weight loss, shortness of breath and have abnormal chest sounds. Many people with bronchiectasis will have chronic sinusitis.

Diagnosing bronchiectasis involves the following:

• Complete history and physical exam
• Chest X-ray and / or CAT scan (diagnostic)
• Pulmonary function tests
• Practically never used anymore is a bronchogram (x-ray procedure that tracks the distribution of dye into the airways, assessing the location and amount of lung that is involved)

Bronchiectasis is best treated by treating the underlying cause.   Your doctor will recommend the best course of action for you. Here are some of the following treatments:

• Sinusitis- corticosteroid nasal spray can be used to decrease swelling and mucus production. Cromolyn sodium nasal spray may be helpful for allergy type symptoms. Saline nasal washes also helps control sinusitis.
• Gastroesophageal reflux- elevate the head of your bed six to eight inches and avoid eating or drinking alcohol, coffee, cola or tea for several hours before bedtime. Antacids or other medications to control heartburn may be needed. Stomach acids can irritate the lungs. In severe cases surgery may be needed to tighten the sphincter at the base of the esophagus.
• Antibiotics- continuous treatment with antibiotics can help sometimes, but drug-resistant organisms can develop in the lung. An antibiotic will be given based on your signs and symptoms.
• Bronchodilators & Corticosteroids- bronchodilators will be used if pulmonary function tests show improvements with the medication. Corticosteroids help to reduce the inflammation in the airways.
• Chest physiotherapy- this is recommended if you are producing an abnormally large amount of mucus or if you are having recurrent infections. You will need an assistant or your doctor may prescribe an electric vibrator for this procedure. It is done by using rhythmic clapping on your back to loosen the mucus and enables it to be drained from the lungs.
• In severe cases, surgery to remove the affected parts of the lung.

Here are some steps you can take to better manage bronchiectasis:

• If you smoke, STOP, and avoid second-hand smoke
• Get your yearly flu shot and pneumococcal vaccine
• Exercise regularly to improve your muscle strength and breathe easier
• Eat a well balanced meal and drink plenty of fluids to help thin the mucus

Bronchiectasis is treatable with routine visits to your doctor and taking medications as instructed. As with any illness always consult with your doctor before doing any kind of treatment or taking any medications.

 

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