Bronchiectasis is a disease characterized by permanent dilatation of areas of the airways. Affected are the bronchi, which are located downstream of the trachea, i.e. deeper in the lung tissue. The dilations are sack-shaped or cylindrical and often filled with purulent fluid.
Causes
The bronchi are part of the respiratory system. Inhaled and exhaled air must pass through them with every breath. There are various causes that can lead to the formation of dilatations in the bronchi, which are medically described as bronchiectasis.
In principle, a distinction is made between two different forms of bronchiectasis. In some, rare cases bronchiectasis can also develop idiopathically. This means that no obvious reason can be found to explain the development of the disease.
- The congenital form can occur in connection with various diseases, whereby cystic fibrosis, Cartagenic syndrome, alpha-1 antitrypsin deficiency and certain forms of pneumonia are listed as triggering causes. Congenital causes may also be based on malformations during the embryonic phase. In this form, bronchial dilatation is present from birth, which is a source of infection.
Overall, the congenital form of bronchiectasis is a very rare disease. – The second form of bronchiectasis is called acquired bronchiectasis. In earlier times, this form of bronchiectasis usually developed as a result of diseases that usually occur in childhood, such as whooping cough or measles.
Today, thanks to relatively widespread standard vaccination, this cause is much rarer. However, the clinical picture of acquired bronchiectasis can still occur today. Several factors can cause this.
Infections and inflammation of the respiratory tract, for example by influenza viruses, can damage them and cause bronchiectasis. It should be mentioned that especially infections that develop during childhood and adolescence can damage the tissue to the extent that bronchiectasis can develop later. Foreign bodies or tumours can also cause dilatation of the airways.
Diagnosis of bronchiectasis
Often affected persons come to their family doctor with typical symptoms of this respiratory disease. The specialists for the diagnosis and treatment of this clinical picture are the specialists in pneumology, for whom the family doctor usually issues a referral. Bronchiectasis is usually diagnosed by means of an imaging procedure: high-resolution computer tomography (HR-CT of the lungs).
The patient’s medical history also gives the treating physicians clues to assess the severity of the disease. The type and duration of the symptoms are particularly important, and whether they are worse in certain situations than in others. Behaviour such as smoking and taking medication, as well as information on whether similar illnesses exist in the family, are also important for the respective doctor.
A physical examination can possibly exclude other respiratory diseases or confirm the diagnosis of bronchiectasis. For this purpose, the attending physician can listen to the lungs and airways with a stethoscope and examine other symptoms (see below). With the help of a lung function test, the functionality of the lungs and airways can also be examined, which can be greatly reduced in bronchiectasis, but also in other clinical pictures. Finally, the MRI of the lung also plays an increasing role. In particular, the contrast medium helium (a gas that is non-toxic to humans) can be used to improve the visualisation of brochiectasia on MRI.
