Bronchiectasis is a condition that occurs secondary to lung damage. When the lungs and airways have been damaged by something like a tumor, an autoimmune response, COPD, or a disease like cystic fibrosis, the airways are widened and permanently damaged. This widening causes thickening of the tissue which essentially scars the lung and renders it ineffective at draining secretions or exchanging gas properly.
The secretions build up and block other small airways. Often the result of this is pneumonia or a lung infection such as pertussis (whooping cough.) Lung function is lost over time and supplemental oxygen may be required.
Patients with this condition will have copious amounts of mucus that is often very sticky. They will have difficulty expelling their secretions and they will usually have audible wheezing due to chronic inflammation and narrowing of the airway. They will exhibit a chronic cough, which can be blood-tinged, fatigue, shortness of breath, weight loss, recurrent lung infections or hospitalizations, and chest pain.
This is not a reversible condition and it is life-long. Over 40% of cases are idiopathic, in other words, no one can pinpoint an exact cause. It is more common in women than men and the risks increase with age.
Conditions that are known to be causative agents include autoimmune diseases, COPD, diabetes, Crohn’s disease or other inflammatory bowel diseases, pulmonary aspiration, and immunodeficiency diseases like HIV.
Treatment for bronchiectasis normally consists of a multi-disciplined approach. The use of exercise, medications, and support therapies are patient options. Pulmonary rehabilitation and PT are great adjuncts. This will allow the patient to exercise in a controlled setting. The patient will learn how to perform ADL’s (activities of daily living) more easily and conserve energy. Medications may consist of antibiotics, steroids, bronchodilators, and/or mucolytics (mucus thinning medications), or supplemental oxygen.
Support therapies may include mental wellness, use of Vest therapy, the flutter valve, or another PEP device to help evoke a cough to clear airways, and nutritional consult. Bronchiectasis is diagnosed by signs and symptoms, chest X-rays or CT scans of the lungs, sputum testing, lung function testing, and blood work.
Untreated bronchiectasis may lead to respiratory or heart failure. Life expectancy after diagnosis for severe bronchiectasis may range from 2 to 40 years depending on many factors (i.e. when the diagnosis occurred, how significant the disease was when it is diagnosed, and if the patient may have other underlying conditions.
However, most can live a normal lifespan and will endure “flair-ups” throughout. There is currently a new investigational drug being tested (INS1007) for this condition. In addition to a primary care physician, a person diagnosed with bronchiectasis should also have a pulmonologist, and if necessary, a cardiologist.
These lung and heart specialists (respectively) will be able to order the proper testing and treatments. To keep healthy, these patients should eat a diet low in all of the “white poisons” (i.e. sugar, salt, flour, and fats). Proper hydration is very important as it helps to thin out secretions. Take all medications as prescribed. Perform all ancillary treatments as prescribed (i.e. vest therapy, PEP therapy, chest physiotherapy, etc.) Stay up to date on vaccinations and try to maintain a healthy lifestyle.
If you want more information, or to speak to a lung health professional, please contact The American Lung Association at 1-800-LUNG USA.
Author Profile: Laura Castricone, Respiratory Therapist
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