Bronchiectasis

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**Bronchiectasis**
*Classification & external resources*
ICD-10	J 47., Q 33.4
ICD-9	494, 748.61
DiseasesDB	1684
MedlinePlus	000144
eMedicine	med/246

Bronchiectasis is defined as a chronic dilation of bronchi or bronchioles as a sequel of inflammatory disease or obstruction. [1] Infection is the mechanism by which the disease progresses.^{[citation needed]} The disease, left untreated, will continue to damage lung tissue and bronchial tubes and cause emphysema and severe breathing difficulties.^{[citation needed]}

Dilation of the bronchial walls results in airflow obstruction and impaired clearance of secretions because the dilated areas interrupt normal air pressure of the bronchial tubes, causing sputum to pool inside the dilated areas instead of being pushed upward. The pooled sputum provides an environment conducive to the growth of infectious pathogens, and these areas of the lungs are thus very vulnerable to infection. The more the lungs experience infections, the more lung tissue and alveoli are damaged, and the more inelastic and dilated the bronchial tubes become, perpetuating the cycle of the disease.

Bronchiectasis was first described by René Laënnec in 1819 and later detailed by Sir William Osler in the late 1800s.^{[citation needed]}

1 Diagnosis
2 Treatment
3 Causes
4 Prevention
5 External links

[edit] Diagnosis

The diagnosis of bronchiectasis is based on a clinical history of daily viscous sputum production and characteristic CT scan findings (such as multiple cysts near the bottom of the lung).^{[citation needed]} A "Tree in bud" pattern may be seen on CT scan. However, bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent lung infections, a trademark symptom of bronchiectasis. Early diagnosis of bronchiectasis is critical in slowing or stopping the disease's progress.

[edit] Treatment

Treatment of bronchiectasis is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications. This includes fighting infections with antibiotics and eliminating the fluid with postural drainage and chest physiotherapy.^{[citation needed]} Surgery may also be used to treat localized bronchiectasis.

A classic bacterium that is seen in people with bronchiectasis is Pseudomonas aeruginosa,^{[citation needed]} which is notoriously resistant to antibiotic treatment. It is controversial whether to give those with bronchiectasis daily antibiotics to prevent infection from happening or whether to treat each time they become ill.^{[citation needed]}

An encouraging new treatment, Bronchitol[2], is under development and in phase III trials and appears to offer a chemical treatment of Bronchiectasis. Mucus gets a lower viscosity and cilia are stimulated to work as they would in healthy lungs. Trials end in Q2 2007 and Pharmaxis (the manufacturer) estimates the drug will be on the market in 2008. Bronchitol has Orphan drug status in Europe and the USA.

[edit] Causes

The most common cause worldwide is scarring from tuberculosis.^{[citation needed]} In the United States, the most common cause is probably cystic fibrosis.^{[citation needed]} Chronic tobacco use (smoking) can also lead to emphysema in 20% of smokers,^{[citation needed]} which can lead to chronic bronchitis and scarring of the bronchi that develops into bronchiectasis.^{[citation needed]} Adults may inherit immunodeficiencies that present as recurrent lung infections that ultimately lead to bronchiectasis.^{[citation needed]} Localized bronchiectasis may also occur distal to an obstruction such as a tumor or inhaled foreign body.

It is characteristic in a number of conditions, particularly Kartagener syndrome.^{[citation needed]}

[edit] Prevention

Non-hereditary bronchiectasis often results from initial injury to the lungs, and thus prevention of injury such as pneumonia is critical, especially in children and immunodeficient individuals.

If injury has already occurred, special care should be taken to prevent relapse of infection:

Vulnerable populations should receive flu and pneumonia shots according to schedule.
Wear appropriate clothing for varying temperatures to avoid weather-related illness.
Get regular exercise, and eat and sleep well.
Avoid overexertion or excess fatigue--timely rest is crucial.
Use of inhalers such as Albuterol (Salbutamol) and Fluticasone (Flovent/Flixotide) may help reduce likelihood of infection by clearing the airways and decreasing inflammation.
If yellow or green sputum develops, seek medical treatment immediately so that the infection can be mitigated as soon as possible. The longer an infection remains in the lungs, the more damage the lungs incur.
Avoid breathing smoke or other irritating substances.