Frequency distribution
Thanks to regular vaccinations and modern antibiotic therapy, acquired bronchiectasis is much rarer today than in the past. Most bronchiectasis in Germany occurs due to other existing diseases, mostly cystic fibrosis. Studies investigating the frequency distribution within a certain population come up with different numbers. A study from the USA describes 52 cases of bronchiectasis per 100,000 inhabitants, whereas a study from Australia describes 3.7 cases per 100,000 inhabitants.
Symptoms
Persons suffering from bronchiectasis mainly complain of a productive cough, i.e. one that produces mucus. Coughing usually produces a mucous, foul-smelling secretion, which can also be bloody and is typical of the clinical picture of bronchiectasis. If the secretion were to be filled into a glass or tube, three layers would be observed.
At the top you would see foam, in the middle mucus and at the bottom deposited pus. Since bronchiectasis is accompanied by severe inflammatory processes in the respiratory tract, non-specific symptoms of inflammation can also be associated with the clinical picture. This would show itself in an increased body temperature, but also in pneumonia.
Since the bronchi are an important part of the respiratory gas exchange system and therefore equally important for the oxygen supply of our body, symptoms are often associated with a reduced oxygen supply. Especially on the hands, these changes can be assessed relatively well in case of chronic oxygen deficiency. There, after some time, watch glass nails and flail fingers appear. The term watch glass nails describes the phenomenon that the connective tissue under the nail enlarges (hypertrophied), and as a reaction to this the nails bulge upwards, thus resembling a watch glass to some extent. The symptom of the drumstick fingers is based on the same cause and describes a change in the finger end phalanges, which become roundishly enlarged in chronic oxygen deficiency.
Therapy
The clinical picture of bronchiectasis is chronic and from today’s point of view there is no cure. Basic diseases that are responsible for the development of bronchiectasis should always be treated first. The current therapeutic principles are based on the attempt to prevent the progression of the disease.
The usual approaches to therapy are generally divided into three different groups. In the case of very advanced disease progression, lung transplantation can also be the last resort. – Drug therapy relies, among other things, on drugs that have an expectorant effect.
These drugs include, for example, N-acetylcysteine, whose long-term use in patients with bronchiectasis is controversial. Sufficient fluid intake is, however, recommended in all cases in affected persons so that the secretion is not too thick and can be coughed up easily. Another drug that is indispensable, especially in cases of frequent inflammation of the airways, is antibiotics.
A targeted therapy using sputum analysis can prevent life-threatening pneumonia and other complications. If the treating physician diagnoses inflammatory reactions of the bronchial tissue, a targeted cortisone therapy may also be indicated. – The second indispensable form of therapy for bronchiectasis is the physical treatment of the patient.
This can and should be partly carried out independently and regularly by the patient himself. Important here is the so-called “bronchial toilet”, where the bronchial secretion should be coughed up daily. It is important that this manoeuvre is carried out precisely so that most of the mucus from the airways is mobilised.
For this purpose, expectorant medication can be taken as a support. First, the secretion should be released by tapping lightly on the upper back and then coughed up vigorously with the upper body lowered and the elbows on the knee. There are various aids that can also make coughing up the mucus easier.
These aids range from vibrating massagers for dissolving the mucus to certain exercises that can be learned to make coughing up easier. Coughing up is important because bacteria accumulate in the secretion, which can cause inflammation and even lead to dangerous complications such as an inflammation of the brain (brain abscess). – The third possibility of treatment, which in some cases can be quite useful, is the surgical removal of lung tissue. However, this only makes sense if the drug and physical therapy is not successful and an operation seems possible and probable. The operation can either remove an entire lobe of the lung (lobectomy) or only part of the lobe, i.e. a lung segment (lung segment resection).
