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Bronchiectasis

Acquired bronchiectasis; Congenital bronchiectasis; Chronic lung disease - brochiectasis

 

Bronchiectasis is a disease in which the large airways in the lungs are damaged. This causes the airways to become wider.

Bronchiectasis can be present at birth or infancy or develop later in life.

Causes

 

Bronchiectasis is often caused by inflammation or infection of the airways that keeps coming back.

Sometimes it begins in childhood after having a severe lung infection or inhaling a foreign object. Breathing in food particles can also lead to this condition.

Other causes of bronchiectasis can include:

  • Cystic fibrosis, a disease that causes thick, sticky mucus to build up in the lungs
  • Autoimmune disorders, such as rheumatoid arthritis or Crohn disease
  • Allergic lung diseases
  • Leukemia and related cancers

 

Symptoms

 

Symptoms develop over time. They may occur months or years after the event that causes the bronchiectasis.

Long-term (chronic) cough with large amounts of foul smelling sputum is the main symptom of bronchiectasis. Other symptoms may include:

  • Breath odor
  • Clubbing of fingers (rare)
  • Coughing up blood
  • Fatigue
  • Paleness
  • Shortness of breath that gets worse with exercise
  • Weight loss
  • Wheezing
  • Low grade fever and night sweats

 

Exams and Tests

 

The health care provider will perform a physical exam. When listening to the chest with a stethoscope, the provider may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lungs.

Tests that may be done include:

  • Aspergillosis precipitin test (to check for signs of an allergic reaction to fungus)
  • Alpha-1 antitrypsin blood test
  • Chest x-ray
  • Chest CT
  • Sputum culture
  • Complete blood count (CBC)
  • Genetic testing, including sweat test for cystic fibrosis and tests for other diseases
  • PPD skin test to check for a past tuberculosis infection
  • Serum immunoglobulin electrophoresis to measure proteins called immunoglobulins in the blood
  • Lung function tests to measure breathing and how well the lungs are functioning

 

Treatment

 

Treatment is aimed at controlling infections and sputum, relieving airway blockage, and preventing the problem from becoming worse.

Daily drainage to remove sputum is part of treatment. A respiratory therapist can show the person coughing exercises that will help.

Medicines are often prescribed. These include:

  • Antibiotics to treat infections
  • Bronchodilators to open up airways
  • Expectorants to help loosen and cough up thick sputum

Surgery to remove (resect) the lung may be needed if medicine does not work and the disease is in a small area, or if the person has a lot of bleeding in the lungs.

 

Outlook (Prognosis)

 

The outlook depends on the specific cause of the disease. With treatment, most people live without major disability.

 

Possible Complications

 

Complications of bronchiectasis may include:

  • Cor pulmonale
  • Coughing up blood
  • Low oxygen levels (in severe cases)
  • Recurrent pneumonia
  • Depression

 

When to Contact a Medical Professional

 

Call your provider if:

  • Chest pain or shortness of breath gets worse
  • There is a change in the color or amount of phlegm you cough up, or if it is bloody
  • Other symptoms get worse or do not improve with treatment

 

Prevention

 

You can reduce your risk by promptly treating lung infections.

Childhood vaccines and a yearly flu vaccine help reduce the chance of some infections. Avoiding upper respiratory infections, smoking, and pollution may also reduce your risk of getting this infection.

 

 

References

Chan ED, Iseman MD. Bronchiectasis. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 48.

O'Donnell AE. Bronchiectasis, atelectasis, cysts, and localized lung disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 90.

 
  • Lungs

    Lungs - illustration

    The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

    Lungs

    illustration

  • Respiratory system

    Respiratory system - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system

    illustration

    • Lungs

      Lungs - illustration

      The major features of the lungs include the bronchi, the bronchioles and the alveoli. The alveoli are the microscopic blood vessel-lined sacks in which oxygen and carbon dioxide gas are exchanged.

      Lungs

      illustration

    • Respiratory system

      Respiratory system - illustration

      Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

      Respiratory system

      illustration

    Tests for Bronchiectasis

     

       

      Review Date: 8/21/2016

      Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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