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What is Bronchiectasis ?

Bronchiectasis is a common lung disease characterised by chronic infection in small airways that results in some parts of the lung becoming damaged, scarred and dilated, allowing infected mucus to build up in pockets.

Causes

Bronchiectasis is caused by chronic infection of the airways. This infection is generally thought to be from bacteria. The persistent airway infection and the immune response results in chronic inflammation. This inflammation damages the lung and results in the symptoms of bronchiectasis.

Conditions associated with bronchiectasis include:

  • Infections that damage the airways (pneumonia, tuberculosis
  • Something blocking off part the airways, for example, a piece of food stuck in the airway
  • Cystic fibrosis
  • Diseases that affect the tiny hairs (cilia) inside the airways, for example, primary ciliary dyskinesia, Kartagener’s syndrome
  • Inflammatory bowel disease also called ulcerative colitis and Crohn’s disease
  • Immune system deficiencies
  • Arthritis disorders such as rheumatoid arthritis
  • A severe allergic response to fungus or moulds such as aspergillus
  • Gastric reflux

Symptoms

The most common symptom of bronchiectasis is a cough that’s chronic (it doesn’t go away) and productive (it brings up phlegm/mucus). Bronchiectasis causes people to cough up large amounts of mucus. The mucus is sometimes yellow or green and it sometimes smells bad.

Other symptoms of bronchiectasis include:

  • Feeling short of breath
  • Chest pain
  • Wheezing
  • Coughing up blood
  • Fever
  • Weakness
  • Weight loss without trying

Diagnosis

You doctor will ask lots of questions about you and your symptoms. If your doctor suspects you may have bronchiectasis, you will have some tests, which are likely to include:

  • A chest X-ray
  • A computerised tomography (CT) scan. A CT scan uses a special X-ray machine to look at your lungs for more details
  • Tests on your sputum to find out if any bacteria are in it
  • Blood tests
  • Lung function tests

Occasionally, your health care professional will suggest a bronchoscopy – using a camera in a narrow tube – to look inside your lungs and take samples.

Sometimes you’ll have further tests, including genetic blood tests, to try to find out why you’ve developed bronchiectasis.

Treatment

Antibiotics

If you get a chest infection or have a flare-up, you’ll take a course of antibiotics, often for 14 days.

Clearing your sputum

Clearing sputum from your lungs is very important and can reduce the number of infections you have and reduce your cough.

Chest physical therapy is a way of loosening the mucus in your chest. People usually do chest physical therapy while sitting or lying with their heads down (postural drainage). The therapy helps loosen the mucus, and lying with your head down helps the mucus drain away from your lungs.

After you’ve loosened the mucus, it’s easier to cough it up. People with bronchiectasis often do CPT and cough up mucus three or four times a day. There are different ways of doing chest physical therapy:

  • Some people use their fist to pound on their chest
  • Other people use a device, for example, an electric chest clapper, an inflated vest, a “flutter” machine or a positive expiratory pressure mask

There are also breathing exercises that help loosen mucus.

If your sputum is sticky, and hard to cough up, your health care professional may suggest:

  • a mucolytic, a drug to break up the sputum and make it easier to clear from your lungs
  • a nebuliser to breathe in a salt solution called saline. This may help if you have frequent infections and find it difficult to clear sputum from your lungs by physiotherapy. The salt water helps break up the sputum and make it easier to cough up.

People with bronchiectasis can get flare-ups, times when their symptoms are worse. If you have bronchiectasis, stay as healthy as possible by:

  • Not smoking and avoiding second-hand smoke
  • Eating a balanced diet
  • Getting the flu shot every year
  • Getting pneumococcal pneumonia shot every few years (ask your doctor)
  • Making sure you’ve gotten shots against measles, rubella, and pertussis
  • Fighting germs by washing your hands properly
  • Getting help right away if you are having a flare-up
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