Bronchiectasis is a disease of lungs occurring as a result of partial or permanent destruction to one or more conducting bronchi or airways. This defect in bronchioles occurs after the previous infections to lungs. The damage is seen in the smooth muscles present in the bronchial tubes. These smooth muscles of bronchial tubes play a very important role in the elasticity of tubes and prevent the secretion of lung tissue to be cleared up.
Bronchiectasis disease comes in the category of chronic obstructive pulmonary diseases of lungs.
Due to recurrent inflammation of the airways (bronchial tubes) they collapse and this collapse causes difficult clearance of secretions (often with impaired cough) ultimately resulting in obstruction of airflow and shortness of breath. Sometimes blood in sputum (hemoptysis) is also seen.
In bronchiectasis part of lungs involved is one segment or one sub-segment or a single lobe. Rarely there is involvement of many sections of lungs, it occurs only when there is an association of other systemic diseases along with it such as CYSTIC FIBROSIS.
Bronchiectasis Is Congenital Disease?
Bronchiectasis is rarely a congenital disease, most commonly it is an acquired from disease due to regular exposure to chemicals of the environment.
Due to recurrent infections, walls of bronchial tubes get fibrosis. As a result, the elastic component in the smooth muscles present in the walls of bronchial tubes is destroyed. Ultimately leading to the weakening of walls of the bronchial tube that leads to slow in movements of tubes and therefore dilation of tubes decreased.
Changes occurring in affected areas are seen as edema, scarring, ulcerations, transmural inflammation.
The final result of the destruction of bronchial walls is impaired dilation and not clearance of secretions.
These secretions then keep on accumulating in lungs and when bacteria’s from outside enters lung they settle on these accumulations and grow.
After settlement on this they colonize and start releasing toxins, these toxins destroy walls and purulent discharges are released. These discharges then become expectoration.
This cycle of damage continues and goes on with recurrent infections.
How To Classify Bronchiectasis
Three types are –
• Cylindrical bronchiectasis
• Cystic bronchiectasis
• Varicose bronchiectasis
In this type of bronchiectasis, there is involvement of diffused mucosa (edema) which results in changes in affected bronchiole as they become straight, with regular outlines and end squarely.
In this type new vessels formed around affected area are involved and ulcerations occur there. This result makes bronchioles appearance balloon shape.
In this type, bronchioles are dilated, seen dispersed sites of construction and sites of obstructive scars. This type complicates as pneumonitis and parenchymal damage.
Bronchiectasis is once thought to be a disease of infants.
It can occur in any age and any sex but most common in older woman.
Bronchial obstruction can occur due to many factors such as bronchial stenosis from infection, Broncho lithiasis, endobronchial tumors, foreign body aspiration.These causes lead to bronchiectasis. Right middle lobe syndrome is the major factor.
There are many organisms involved in primary infection of lungs. Organisms are as following:-
• Pertussis virus
• Measles virus
• Staphylococcus aureus
• Herpes simplex virus
• Nontuberculous mycobacteria
• Mycobacterium tuberculosis
• Mycoplasma pneumonia
This disease involves almost every organ of the body so it affects lungs also and cause fibrosis of lung tissue, especially of bronchioles.
Young syndrome presents three characteristic diseases bronchiectasis, sinusitis and obstructive azoospermia.
Bronchopulmonary allergic aspergillosis
In this disease immune system respond to Aspergillus antigen when inhaled and reaction to is bronchospasm and bronchiectasis.
After aspiration of foreign products or gastric material (peptic juices in cases of in lungs it leads to post-obstructive pneumonia that finally result in bronchiectasis.
Other causes are
• Relapsing polychondritis
• Systemic lupus erythematosus
• Sjogren syndrome
• Regular to external environmental polluted agents
• Long history of a cough with large amount of offensive sputum
• Blood on coughing along with sputum
• Odour of breath
• Clubbing is seen in fingers
• Breathing is short during exercise
• Weight loss
On examination of chest by a doctor with stethoscope, it is found
Clicking in lower lobes of chest
• Culture of sputum
• Complete blood count(CBC)
• X-ray chest anterior-posterior view and lateral views
• Alpha 1 antitrypsin blood test
• Aspergillosis precipitin test
• CT scan of chest
• PPD skin test
• Serum immunological electrophoresis
Future of the disease depends upon the cause of bronchiectasis.
Many cases are treated but complications lead to disability.
• Repeated attacks of pneumonia.
• Blood in expectoration on coughing.
• Cor pulmonale.
• Oxygen levels are low in the blood.
In acute cases of obstruction to airways and difficulty breathing relieving of air, the passage is most important.
Daily drainage of accumulated secretions is must from lungs.
Antibiotics are used in cases of fever with infection.
Bronchodilators are used in cases of difficulty in breathing.
•Very well indicated medicine for bronchiectasis.
•Great rattling of mucus, but very little is expectorated.
•Burning sensation in the chest which ascends to the throat.
•Bronchial tubes are overloaded with mucus.
•Cough is excited by eating, bichrome with pain in chest and larynx.
•Dyspnoea is relieved by eructation.
•There is tickling in larynx.
•Cough with pain in the sternum, extending to shoulders worse when undressing.
•Catarrhal laryngitis cough a brassy sound.
•Metallic, hacking cough.
•Pain at the bifurcation of trachea on coughing, from mid-sternum to back.
•Hoarse, mucus expelled by a forcible cough.
•Cough gets excited by laughing.
•An influenza cough from noon to midnight with scanty expectoration.
•Respiration of patient is short, oppressive, stitches in left side when breathing and lying on the same side.
•Chest feels sore.
•Cough troublesome when walking.
•Anxious, wheezing, moist breathing, asthma worse in the dry cold air.
•Cough is choking.
•Croup with loose, rattling cough worse in morning.
•Loses voice and coughs when exposed to dry, cold wind.
•Rattling, crocking cough, has suffocative attack have to rise up and bend head backward.
•Cough of the patient is very loose.
•Hectic fever and night-sweats, with irritating, shot a cough and scanty.
•Bronchitis, and phthisis,with mucho-purulent,thick,creamy expectoration
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