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Bronchiectasis

Acquired bronchiectasis; Congenital bronchiectasis

 

Bronchiectasis is a disease in which the large airways in the lungs are damaged. As a result of this damage, the airways become wider.

  • If the condition is present at birth, it is called congenital bronchiectasis.
  • If it develops later in life, it is called acquired bronchiectasis.

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.

Cystic fibrosis causes about a third of all bronchiectasis cases in the United States. Certain genetic conditions can also cause bronchiectasis. These conditions include primary ciliary dyskinesia and immunodeficiency syndromes.

The condition can also occur when people often breathe in food particles while eating.

 

Symptoms

 

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

Symptoms may include:

  • Bluish skin color
  • Breath odor
  • Chronic cough with large amounts of foul-smelling sputum
  • Clubbing of fingers
  • Coughing up blood
  • Cough that gets worse when lying on one side
  • Fatigue
  • Paleness
  • Shortness of breath that gets worse with exercise
  • Weight loss
  • Wheezing

 

Exams and Tests

 

When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lungs.

Tests may 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
  • PPD skin test to check for a past tuberculosis infection
  • Serum immunoglobulin electrophoresis

 

Treatment

 

Treatment is aimed at controlling infections and sputum, relieving airway obstruction, and preventing complications.

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

Medicines are often prescribed. These include antibiotics, bronchodilators, and expectorants.

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 patient 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

 

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

 

When to Contact a Medical Professional

 

Call your doctor 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

Feldman C. Bronchiectasis: new approaches to diagnosis and management. Clin Chest Med. 2011;32:535-546.

Iseman MD, Chan ED. Bronchiectasis. In: Mason RJ, Broaddus CV, Martin TR, et al., eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 42.

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    A Closer Look

     

      Tests for Bronchiectasis

       
         

        Review Date: 8/25/2014

        Reviewed By: Denis Hadjiliadis, MD, 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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