Bronchiectasis
Introduction: This strange medical term is composed of
two Greek words: "bronkos" meaning "breathing tube" and "ektasis"
meaning "stretching" or "extension". This image
of bronchiectasis shows that there is usually an accumulation of
several bronchiectasis. These dilatations of abnormal bronchial tubes are due
to a loss of the muscular and elastic layers of the chronically infected bronchial
tubes within one of the lung segments. Chronic bronchitis in longterm smokers
often leads to such destruction and multiple bronchiectasis. However, bronchiectasis
can also be found in the upper lobes of the lungs, which is typical for tuberculosis.
Another disease that is associated with bronchiectasis is cystic fibrosis (a congenital
lung disorder with a lack of surfactant production). Viral illnesses such
as measles, pertussis and influenza in unimmunized people can cause bronchiectasis
following one of these viral diseases. Signs and symptoms: Chronic cough, fever, weight loss and the chronic production
of secretions that look like pus are all associated with bronchiectasis. This
pussy mucous comes from the dilated diseased bronchial tubes, which are infected
with problem bacteria like Pseudomonas aeruginosa, Staphylococcus aureus and Haemophilus
influenzae, all of which are very difficult to treat successfully with antibiotics.
Bronchiectasis often is associated with a chronic lack of oxygen in the system
and this leads to clubbing
of the fingers. Coughing up of blood (=hemoptysis) is also commonly
found. Diagnostic tests: Chest X-rays show characteristic
signs such as the "toothpaste lines" and "tram tracks" or
"tram lines", which when present are characteristic of bronchiectasis.
However, the details are much more visible (in almost all bronchiectasis cases)
with the a lung CT scan, particularly the high
resolution CT scan (=HRCT) as can be seen in this link. In some cases
the respirologist may decide to do a bronchoscopy, just to rule out other pulmonary
diseases such as lung cancer, congenital abnormalities, tuberculosis or to obtain
a good sample of pus right from where the source is inside the bronchial tube
affected by a bronchiectasis. The physician likely will order several samples
of sputum and send this for laboratory analysis with culture and sensitivity testing
to a battery of antibiotics. This way the physician can be guided by the results
of the best fit of antibiotic activity against a particular bacterial strain isolated. Treatment:
Treatment in the earlier cases of bronchiectasis is directed against
the chronic infection in an attempt to prevent further deterioration of the condition
and to prevent pneumonia. Broad spectrum antibiotica are used such as amoxicillin,
tetracycline, or trimethoprim-sulfamethoxazole, if a mixed bacterial flora is
shown to be present on cultures from the coughed up secretions (=sputum cultures).
However, often there are problem bacteria present with flare-ups such as Pseudomona
aeruginosa and special antibiotics such as ticarcillin, gentamycin, tobramycin,
ceftazidime, and ciprofloxacin have to be used for a period of time. If there
is an underlying chronic bronchitis problem that has caused the bronchiectasis
many physicians use one of the broad spectrum antibiotics to keep the infective
process under control (prophylactic antibiotic), but will do sputum cultures with
flare-ups from time to time and switch the antibiotics to one, which will be effective
against the particular bacterium found at that time. Other physicians do not want
to use prophylactic antibiotics for fear of creating "superbugs" that
can be resistant against most or all known antibiotics (Ref. 4, page 1331). Along
with the antibiotic therapy chest physiotherapy is given and can be learnt by
family members and be administered at home. Clapping of the chest wall, postural
drainage and deep breathing exercises are all part of this regime. By draining
the secretions from the lungs bacteria have less fluid on which to grow. Surgery:
If the bronchiectasis condition is confined to one or two lung segments, surgical
removal of this segment can be considered. The mortality in most centers in the
US is now 1% to 2% in the hands of a chest surgeon. Considering how sick these
patients are, this is considered low. However, surgery can only be contemplated,
if the bronchiectasis condition is cvonfined to one area of a lung. In cases where
there is an acute coughing up of blood (called "hemoptysis"), the chest
surgeon may have to remove a particularly bad area of the lung where a bronchial
artery has been eroded from a pus pocket of a bronchiectasis. Prevention:
The key as in many medical illnesses is prevention of bronchiectasis.
To avoid cigarette smoking will prevent chronic bronchitis, one of the major causes
of this disease. Immunization against measles, pertussis and influenza prevents
major damage to the bronchial tubes. Any bacterial infection of the airways must
be treated aggressively with antibiotics in order to prevent the erosion of the
muscular and elastic layers of the bronchial tube, which is at the core of the
development of bronchiectasis. Here you can find more
info about bronchiectasis. |
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