Bronchiectasis is pathological and irreversible enlargement of the bronchial tubes, primarily due to infectious diseases and associated with recurrent (repeated) respiratory illness. Due to the vaccine and antibiotic therapies available today, bronchiectasis is rarely diagnosed.
What are bronchiectasis?
Bronchiectasis refers to abnormal cylindrical or saccular enlargements of the bronchi that are irreversible. There is a disturbance of the mucociliary apparatus (self-cleaning system of the bronchi) in the bronchi due to increasing deposition of bronchial secretions (bronchial mucus) as a result of recurrent respiratory or infectious disease. As a result, the person affected by bronchiectasis exhibits a chronic cough with sputum rich in mucus. Since bronchial secretions are difficult to cough up and their removal from the bronchial dilatations is severely restricted, they accumulate there and promote bacterial colonization and proliferation. People affected by bronchiectasis have a correspondingly increased susceptibility to infectious diseases.
Causes
Bronchiectasis is differentiated between acquired and congenital forms. In congenital bronchiectasis, the disease may be due to impaired differentiation of the alveoli (air sacs in the lungs), structural abnormalities of the cilia (cilia that ensure clearance of bronchial secretions), or genetic disorders such as alpha-1 antitrypsin deficiency or cystic fibrosis. Because these diseases involve a dysfunction of the mucociliary apparatus, the clearance of bronchial secretions is severely restricted, and bronchiectasis may develop as the disease progresses. Acquired bronchiectasis, which represents the majority of cases, often develops as a result of recurrent respiratory diseases such as chronic bronchitis or pneumonia, as well as infectious diseases such as tuberculosis, measles, or pertussis, especially when these occur in childhood. Bronchial constriction due to foreign bodies, tumors in the bronchial area, or enlarged lymph nodes (in the case of lymph node tuberculosis) can also lead to bronchiectasis. In idiopathic bronchiectasis, the disease cannot be attributed to any cause.
Symptoms, complaints, and signs
Bronchiectasis primarily causes a severe cough associated with mucopurulent sputum. The secretions have a sweet, foul odor and are often interspersed with blood or pus. The purulent sputum may be noticed mainly in the morning. As a result of chronic inflammation and suppuration of the bronchial tubes, other symptoms such as fever or shortness of breath are added to the moist cough. Chronic oxygen deficiency is manifested by clock glass nails, drumstick fingers and a decrease in physical and mental performance. In individual cases, bacterial infections of the bronchial tubes and lungs occur. In the worst case, there is a pronounced pneumonia, which is manifested by acute breathing difficulties, severe pain and an increasing feeling of illness. The lungs are also more susceptible to fungal infections and purulent encapsulations. If the bacteria enter the brain via the bloodstream, a brain abscess may develop. This manifests itself, for example, by neurological deficits, headaches and unconsciousness. Bronchiectasis usually forms in the small to medium-sized bronchial tubes. They can be recognized by the typical reddening of the bronchi. In addition, the bronchi are much more sensitive to pain, and acute reactions such as nausea and sweating occur when touched.
Diagnosis and course
In bronchiectasis, initial suspicion is based on the typical chronic cough with sputum. Furthermore, rales and whistling sounds (wheezing) are perceptible when listening to the bronchi. To confirm the diagnosis of bronchiectasis, various other examinations can be performed. The pathogen can be determined by analyzing the blood and sputum. An ECG (electrocardiogram) can be used to check whether there is already any impairment of the heart muscle (right heart failure). The diagnosis is confirmed by X-rays and an HRCT (high-resolution computed tomography) of the lungs, which can be used to detect bronchiectasis. In addition to a chronic cough and repeated infections, bronchiectasis is also associated with fever, fatigue and hemoptysis (coughing up blood).If left untreated, bronchiectasis leads to heart failure. If bacteria spread via the blood to other parts of the body, there is a risk of brain abscess (purulent inflammation). To avoid further complications (obstructive bronchitis, pneumothorax), consistent and adequate therapy is essential.
Complications
In bronchiectasis, the saccular dilatations of the bronchi lead to damage of the bronchial walls over time. As a result, the bronchi permanently dilate and tend to partially retain the mucous secretions that are continuously produced. As a result, a vicious cycle of recurrent infections develops. In addition, fungal colonization of the dilated bronchial vessels can occur with the development of fungal colonies (aspergillomas). In bronchiectasis, the most common complications are pulmonary hemorrhage, lung abscess, brain abscess, collapse of a lung lobe (pneumothorax), and pneumonia. One of the most feared complications is chronic obstructive bronchitis. The increase in pressure in the lungs often leads to permanent overload of the right ventricle (cor pulmonale). Pulmonary hypertension leads to right heart failure with the following symptoms: swelling of the liver with pain under the right costal arch, icterus, and the formation of edema, especially in the legs. Right heart failure is a life-threatening consequence of right heart failure. Effective treatments reduce the symptoms of bronchiectasis and prevent irreversible sequelae. If a complication occurs, it will adversely affect the course of the disease. With the introduction of modern antibiotic therapies, complications that were once common are now rare. In addition, good prevention is important.
When should you go to the doctor?
When typical symptoms such as a long-lasting irritating cough or recurrent coughing attacks with purulent sputum occur, a doctor must be consulted. Medical clarification is necessary at the latest in the case of hemoptysis, fatigue, and febrile episodes. Although bronchiectasis is not always present, it is at least a serious disease of the lungs and throat that must be diagnosed and treated. If there are repeated episodes of bronchitis and pneumonia, an immediate visit to the doctor is recommended. In case of shortness of breath and cardiovascular problems, an emergency physician should be alerted. As it progresses, drumstick fingers, watch glass nails and similar symptoms may occur. These outward signs are grounds for prompt medical evaluation. Patients with chronic lung disease, bronchial asthma, tuberculosis, or whooping cough should see a physician with unusual symptoms. Patients with cystic fibrosis or Kartagener’s syndrome are particularly susceptible to bronchiectasis and should talk to their doctor at the first sign of lung disease. If the pathological expansions are detected early, they can be treated successfully and usually without complications.
Treatment and therapy
If the bronchiectasis can be localized in a clearly demarcated manner, the affected tissue parts can be surgically removed (surgical resection). In particularly pronounced cases, lung transplantation may be necessary. In addition, bronchiectasis is usually treated conservatively. Antibiotic therapy is an essential component in preventing bacterial colonization and spread to the lungs and other parts of the body. For this purpose, an antibiogram can be used to test the infectious agents for antibiotic resistance. In addition, mucolytics (mucolytic agents) can be used to dissolve the bronchial secretions in the affected areas, as well as cortisone inhalers to reduce an inflammatory reaction. Another important part of the treatment of bronchiectasis is physiotherapy, which is intended to help clear the bronchial tubes of bronchial secretions and optimize performance. Patients affected by bronchiectasis learn breathing exercises to prevent dry coughing (lip brakes), techniques to promote the expectoration of bronchial secretions (drainage positioning, huffing, inhalation) and to relieve respiratory distress (breathing and relaxation techniques such as the coach seat).To improve the general performance of the bronchi, regular sports activities that support the respiratory muscles (pulmonary sports) are recommended in bronchiectasis, depending on the functional capacity of the lungs and heart of the particular person affected by bronchiectasis.
Outlook and prognosis
In most cases, bronchiectasis results in a favorable disease outcome. In this case, bronchiectasis can be removed by surgery, which completely relieves the symptoms. However, they can also be combated with the help of antibiotics if their spread is not yet too high. In the worst case, the affected person is dependent on a lung transplant. If the bronchiectasis is not treated, the symptoms worsen and the infection spreads to other parts of the body. In the worst case, this can also lead to the death of the affected person. Respiratory distress occurs, resulting in significant limitations in the patient’s life and daily routine. However, bronchiectasis can recur even after successful treatment, so that renewed treatment is necessary. Especially people with a weak immune system and people in old age can be strongly affected by the symptoms of this disease. After treatment, various breathing exercises are usually still necessary to fully restore the function of the lungs. If the treatment is successful, the patient’s life expectancy is not reduced by the disease.
Prevention
Although no preventive measures exist for bronchiectasis, a healthy lifestyle (healthy diet, regular exercise, no smoking) can help strengthen the immune system and protect against infectious diseases and respiratory infections. Flu shots and pneumococcal vaccinations further protect the body and can prevent further complications of bronchiectasis.
Follow-up
In most cases, the options for aftercare for bronchiectasis are severely limited or almost impossible. The affected person is thereby dependent on permanent therapy, since the disease cannot be completely treated. In some cases, the symptoms can even lead to the death of the affected person or significantly limit the patient’s life expectancy. Since the disease is treated in most cases with the help of antibiotics, care must be taken to ensure that the medication is taken regularly. Likewise, antibiotics must not be taken together with alcohol, so that alcohol must be avoided during the entire therapy. The patient should also refrain from smoking and generally from taking nicotine in order to protect the lungs. The patient should also refrain from strenuous activities or sports in order to avoid unnecessary strain on the body. In severe cases, however, the affected person is dependent on the transplantation of a lung in order not to significantly reduce life expectancy. A healthy lifestyle with a healthy diet also has a positive effect on the course of the disease. Furthermore, contact with other sufferers of this disease may also prove useful.
What you can do yourself
For bronchiectasis, various home remedies and methods are available for self-help. In support of drug or surgical treatment, bed rest and sparing are recommended above all. To avoid further coughing attacks and lung pain, attention should also be paid to a diet that is gentle on the lungs. Irritating foods should be avoided for some time after treatment. Healthy foods such as fruits, vegetables and whole grains should be permanently on the diet. In the first period after surgery, medicinal herbs can be used to relieve cough and pain. Among others, anise, lungwort, myrtle and thyme have proven to be effective. These remedies can either be drunk as a tea or applied to the throat and neck in the form of compresses and poultices. Schüssler salts and other homeopathic preparations are also suitable, but should be used in consultation with the doctor in charge. To prevent bronchiectasis from spreading, the disease should be completely cured. In particular, the throat and pharynx should always be kept warm. Affected persons should also drink plenty of fluids and eat slowly. If further symptoms occur despite these measures, a doctor must be consulted.