Bronchiectasis

Content

Introduction

With the term bronchiectasis it indicates an abnormal and permanent dilation of the bronchi which induces a chronic formation of variable quantities of mucus, frequently associated with a greater ease of developing lung infections.

Lung infections can lead to worsening of manifestations. Bronchiectasis are distinguished in congenital if present already in the first ages of life and acquired if they appear at an older age. They can also be localized to a small lung area or diffuse.

Causes

It is not always possible to know the cause that determines the onset of this disease. Often, especially in localized forms, it represents the final result of a pulmonary infection and consequent inflammation, events that can determine the destruction of the bronchial wall.

The lungs are continually exposed to germs, but the body has multiple defense mechanisms to defeat lung infections. If a foreign agent (such as a bacterium or virus) manages to overcome these defenses, the immune system will try to prevent it from spreading. White blood cells participate in these defense mechanisms by releasing chemicals which, while fighting infections, in turn cause inflammation of the surrounding tissues. In most cases these inflammations heal without creating further problems, but in some patients the inflammation does not subside. and destroys the elastic tissues and muscles surrounding the bronchi, causing their permanent dilation.

In the diffuse forms of bronchiectasis the alteration of the pulmonary defense mechanisms prevails and there is also an alteration of the cilia, present in the bronchi, which with their movement contribute to the elimination of mucus and to the cleansing of the bronchi.

Clinical manifestations

The most common respiratory disorders (symptoms) are related to the extension of bronchiectasis, the most common are:

  • chronic persistent cough
  • more or less abundant phlegm
  • presence of blood in the phlegm
  • breathing difficulties of varying degrees

These symptoms can be more or less frequent (occasional, daily) and occur with different levels of severity. The most common symptom of bronchiectasis is a persistent cough accompanied by the production of a variable amount of phlegm of different colors (clear, pale yellow or greenish yellow). In some people, however, especially in the early stages of the disease, phlegm is either not present or very scarce.

Other associated disorders can be:

  • chest pain
  • rhinitis and chronic sinusitis
  • "Drumstick fingers" (enlargement of the distal phalanges at the ends of the fingers, probably due to chronic reduced oxygenation of the blood)

In the presence of a lung infection, symptoms worsen within a few days and there may be more production of greenish and foul-smelling phlegm than usual, sometimes accompanied by the presence of blood. Breathing may become even shorter, fatigue, general malaise may be present. Chest pain can get worse; persistent chest pain may be a sign of inflammation of the pleura. In the presence of one or more of these disorders it is necessary to go to your doctor.

Since some people with bronchiectasis can develop a severe lung infection, it is important to pay attention to some manifestations that require immediate intervention by the pulmonologist:

  • high fever greater than 38 °
  • wheezing (more than 25 breaths per minute)
  • presence of cyanosis of the lips (blue lips)
  • severe pain in the chest, which also makes coughing and phlegm difficult
  • sense of mental confusion

If any of these complaints occur, you should immediately contact your general practitioner or pulmonologist or, if this is not possible, call the emergency number 118.

Diagnosis

In the presence of persistent cough it is always good to check with the family doctor, since even if not necessarily due to bronchiectasis, it is still a signal that should not be overlooked. The medical examination consists in communicating one's symptoms to the doctor, in undergoing a general and then specific medical examination of the chest by listening to the lungs with the stethoscope. People with bronchiectasis often experience characteristic noises during the breath.

The doctor, after a thorough examination, will prescribe, if necessary, a chest X-ray or a chest CT scan also in order to properly exclude other lung diseases. In the event of a suspected lung infection, an analysis of phlegm (sputum) will be prescribed to check for the presence of bacteria. After performing the diagnostic tests, the treating physician may evaluate the advisability of requesting a visit from the specialist in diseases of the lung. respiratory system, the pulmonologist, in order to obtain an opinion on the tests performed, a suggestion on any further necessary investigations and a therapeutic indication.

The main test to ascertain (diagnose) the presence of bronchiectasis is the high-resolution CT scan of the chest without contrast.

The images obtained, read by a computer, provide a detailed view of the lungs and bronchi. In healthy people, the bronchi appear as branches of a tree that become thinner and thinner towards the periphery. In people with bronchiectasis, on the other hand, the CT scan confirms or excludes the presence of the same on the course of some bronchi, highlighting a dilation (enlargement) of one or more bronchial branches, characterizing their localization and extension, representing the presence of any complications. some cases of the presence of symptoms of sinusitis, especially in patients with diffuse bronchiectasis, it is necessary to perform a CT scan of the paranasal sinuses.

Other useful tests in the presence of bronchiectasis are:

  • sputum examination, to check for the presence of bacteria or fungi in the phlegm
  • blood tests, such as blood count, ESR, C reactive protein to highlight a state of inflammation or infection, immunoglobulin dosage to check the functionality of the immune system
  • sweat test, it is performed after having stimulated sweating in a small area of ​​the patient's skin, the sweat taken is examined to evaluate some alterations characteristic of cystic fibrosis
  • respiratory function test to check the severity of the disease. The test is performed using a device called a spirometer, spirometry is useful for measuring how much air our lungs contain and how this air moves through our bronchi.
  • bronchoscopy, the examination is performed by introducing through the nose into the trachea up to the more peripheral bronchi, a flexible tube equipped with a light source and a camera at the end; the examination allows you to take small amounts of mucus or tissue (biopsy) to be analyzed in the laboratory under a microscope. The examination is particularly useful, in the presence of bleeding, to assess the location of the bleeding and the possible presence of neoplastic changes (tumors)

Therapy

Bronchiectasis causes permanent damage to the lungs, but treatment is helpful in preventing symptoms from worsening.

In most cases, the treatment (therapy) consists of a combination of drugs, the use of medical devices that help the person keep the bronchi clean and exercises to learn in order to perform them independently.

In case of bacterial infection it is necessary to take the antibiotics prescribed by the doctor. The doctor may request a sputum test to find out the type of bacteria causing the infection. The test result will be available after a few days but the doctor can prescribe, pending the result, broad spectrum antibiotics, effective against bacteria believed to be responsible for the infection. If symptoms of infection are severe, specialist checkups and hospitalization may be required.

Sometimes the drugs shown to keep the bronchi clean must be given with a device called a nebulizer.

Nebulizers are very popular devices used for the therapy of various respiratory diseases. They are equipped with a compressor, ampoule to insert the drugs, mouthpiece, mask and transform the liquid drug inserted in the ampoule into an aerosol. The aerosol is inhaled by the patient with minimal collaborative effort and is deposited in the respiratory tract.It is a device that converts the drug used into an aerosol. The drugs to be nebulized serve to reduce the density of the mucus facilitating its expulsion. The nebulizer can also be used to administer antibiotics, if necessary. In the event of serious disorders, the doctor can prescribe bronchodilator drugs, to be used only for short periods Bronchodilators are drugs that are mainly taken by inhalation and their function is to relax the bronchial muscles, favoring breathing.

Surgical treatment is recommended in cases in which bronchiectasis affect a part of the lung (called lung lobe), when the disturbances (symptoms) persist despite treatment and in the presence of episodes of blood emission that are difficult to control with therapy.

There are also some measures to be taken to improve the ailments (symptoms) or prevent them from getting worse:

  • stop smoking
  • annual flu vaccination
  • pneumococcal vaccination, which protects against pneumonia caused by Pneumococcus. This vaccine is given only once
  • physical therapy by performing regular exercises that help reduce the amount of mucus in the bronchi
  • constant and optimal hydration
  • healthy and balanced diet to be carried out under medical supervision

There are numerous types of exercises that help reduce the amount of mucus present in the bronchi; it is therefore necessary to contact an expert physiotherapist who knows how to teach the person with bronchiectasis the most suitable exercises to be performed even at home.

Complications

In some cases in the course of bronchiectasis complications may occur that require urgent intervention, as occurs in the presence of cough accompanied by the leakage of an abundant quantity of blood (massive hemoptysis).

In this case, the following disorders (symptoms) can occur:

  • coughing up copious amounts of blood throughout the day
  • breathing difficulties caused by the presence of blood in the airways
  • dizziness and sweating

Massive hemoptysis is a medical emergency so, if it occurs, it is necessary to call 911 for urgent hospitalization, where a bronchial arterial embolization could be performed to stop the bleeding. Embolization consists in injecting the arteries with a dye (contrast medium) which makes them visible under X-rays and subsequently, with radiological guidance, locating the source of bleeding in order to occlude it by introducing tiny particles the size of a grain of sand , which will stop the bleeding.

Bibliography

NHS. Bronchiectasis (English)

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