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Bronchiectasis

Idiopathic bronchiectasis


Presentation

  • This case illustrates an atypical presentation of this disease and the diagnostic dilemma that the physician may be faced with. CASE PRESENTATION: A 39-year-old woman presented with chronic cough, haemoptysis and hoarseness of voice.[ncbi.nlm.nih.gov]
Fever
  • A 21-year-old woman presented to our hospital with a 9-day history of productive cough and fever. Bronchiectasis after Mycoplasma pneumoniae pneumonia. The patient was treated with azithromycin for 7 days.[ncbi.nlm.nih.gov]
  • Usually there is no fever or pain but if the small infection is not treated, it can become a large, more serious infection which may then be associated with cough, chronic sputum production, hemoptysis (bloody sputum), recurrent fever, shortness of breath[maclungdisease.org]
  • Tuberculosis Presenting features may be malaise, easy fatiguability, anorexia, weightloss, afternoon fever, cough and haemoptysis.[ndri.com]
Fatigue
  • A single session of oscillatory PEP therapy (Flutter) generated a similar level of fatigue as ACBT with GAD, but greater fatigue was noted with oscillatory PEP therapy compared to ACBT alone.[ncbi.nlm.nih.gov]
  • We ask about general symptoms (anxious mood, depressed mood, fatigue, pain, and stress) regardless of condition. Last updated: January 31, 2019[patientslikeme.com]
  • Other physical manifestations include chest pain, snoring, finger clubbing, fatigue, persistent cough, recurrent infection, and loss of appetite [3]. Stress incontinence can also be a result of excess coughing.[physio-pedia.com]
  • Although the patient generally feels well – without fever or pain--fatigue, weight loss, shortness of breath and wheezing can also present. Bronchiectasis can be treated in a number of ways including antibiotics and chest physiotherapy.[blausen.com]
Weight Loss
  • In addition to the weight loss, she had suffered from a chronic cough secondary to bronchiectasis and had been investigated for a suspected gastrointestinal malignancy.[ncbi.nlm.nih.gov]
  • Although the patient generally feels well – without fever or pain--fatigue, weight loss, shortness of breath and wheezing can also present. Bronchiectasis can be treated in a number of ways including antibiotics and chest physiotherapy.[blausen.com]
  • Symptoms of Bronchiectasis The signs and symptoms of bronchiectasis may include the following: Chronic sinusitis Coughing, which can produce mucus (may be discolored, foul-smelling, and contain blood) Fatigue Shortness of breath Weight loss Wheezing It[nationaljewish.mountsinai.org]
  • Severe infection produces fatigue and growth retardation in children or weight loss in adults.[britannica.com]
Hypoxemia
  • Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality.[ncbi.nlm.nih.gov]
  • Onen et al. [49] showed that, in NCFB, factors associated with higher mortality were advanced age, poor functional status, more severe disease based on radiographic findings, and evidence of hypoxemia or hypercapnia.[oxfordjournals.org]
  • The presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent can greatly affect the mortality rate from this disease.[en.wikipedia.org]
  • In advanced cases, hypoxemia and right-sided heart failure due to pulmonary hypertension may increase dyspnea. Hemoptysis, which can be massive, occurs due to airway neovascularization.[merckmanuals.com]
Chills
  • Symptoms of bronchiectasis The symptoms associated with bronchiectasis can vary from person to person, but they most often include the following: Daily coughing up yellow or green mucus Shortness of breath Chronic fatigue Fevers and/or chills Wheezing[lunginstitute.com]
  • For example, a patient with tuberculosis may have bloody sputum, fever, chills, and night sweats. A person with Crohn's disease may have abdominal pain and diarrhea. Congenital bronchiectasis often becomes apparent because of recurrent pneumonia.[emedicinehealth.com]
Cough
  • Effective coughing often assisted by physiotherapy is a cornerstone of bronchial toileting in bronchiectasis. Some patients however have ongoing non-productive cough symptoms suggesting a cough sensitisation syndrome.[ncbi.nlm.nih.gov]
  • Expectorants and Mucus-Thinning Medicines Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus. Expectorants help loosen the mucus in your lungs.[web.archive.org]
Sputum Production
  • Inhaled steroids may have a role in the management of bronchiectasis by reducing cough and sputum production.[ncbi.nlm.nih.gov]
Chronic Cough
  • It is increasingly identified during investigations into chronic cough and is evident high resolution CT scanning.[ncbi.nlm.nih.gov]
  • No longer mainly a complication after pulmonary infection with Mycobacterium tuberculosis, diverse disease processes and mechanisms have been demonstrated to result in the chronic cough, purulent sputum production, and airway dilation that characterize[dx.doi.org]
Hemoptysis
  • Pulmonary hemangioma is a rare thoracic condition that can lead to hemoptysis.[ncbi.nlm.nih.gov]
  • Hemoptysis is common and may occur in as many as 50% of patients. Episodic hemoptysis with little to no sputum production (dry bronchiectasis) is usually a sequela of tuberculosis.[emedicine.com]
Productive Cough
  • A 27-year-old woman presented to an affiliated hospital with a 1-year history of productive cough. Bronchiectasis. The patient was treated with cephalosporin and a mucus clearance regimen for 6 days and then with Chinese herbs for 3 months.[ncbi.nlm.nih.gov]
Failure to Thrive
  • Steatorrhea and failure to thrive are also common features of CF. Immunodeficiency states that predispose the child to repeated lower respiratory tract infections are another common underlying cause of bronchiectasis.[clinicaladvisor.com]
  • […] to thrive, enlargement or absence of lymphoid tissues, unexplained organomegaly, unexplained joint symptoms).[patient.info]
  • There may be a history of: Failure to thrive. Recurrent lower respiratory tract infections. Symptoms of bronchiectasis include: Chronic cough — usually productive but may be unproductive. Wheeze. Haemoptysis (usually blood-streaked sputum).[web.archive.org]
Halitosis
  • Clinical findings Halitosis, paroxysmal coughing, expectoration of mucopurulent matter; it may affect the bronchioles uniformly (cylindric bronchiectasis), occur in irregular pockets (saccular bronchiectasis) or dilated bronchi may have terminal bulbous[medical-dictionary.thefreedictionary.com]
  • Halitosis and abnormal breath sounds, including crackles, rhonchi, and wheezing, are typical physical examination findings. Digital clubbing is uncommon but may be present.[merckmanuals.com]
  • Hypersecretion of the airways predominates in the morning or with changes in position, the patients can present with hemoptysis, weight loss, lack of appetite, halitosis, lethargy and prostration.[doi.org]
Cyanosis
  • […] infections (whooping cough, pneumonia, measles) local disease (foreign body, adenoma, Tb) allergic bronchopulmonary aspergillosis (proximal bronchiectasis) CLINICAL FEATURES History chronic cough purulent sputum Examination fever cachexia sinusitis cyanosis[lifeinthefastlane.com]
  • Signs: On general examination-Emaciation, cyanosis and clubbing-of fingers seen in advanced cases. On chest examination: Inspection: Retraction of Chest wall Palpation: Diminished thoracic expansion.[ndri.com]
  • Depending up on the severity of disease and how long it has been present, other findings may include weight loss, cyanosis (a bluish color of the skin and the mucous membranes due to an insufficient level of oxygen), and right heart failure (manifested[emedicinehealth.com]
Lip Cyanosis
  • Signs and symptoms of serious lung infection include: a bluish tinge to the skin and lips (cyanosis) confusion a high temperature of 38C (100.4F) or above rapid breathing (more than 25 breaths a minute) severe chest pain that makes it too painful to cough[nhsinform.scot]
Mitral Valve Prolapse
  • Cardiovascular abnormalities in PKD involve hypertension, mitral valve prolapse, intracranial aneurysms and pulmonary abnormalities include primary ciliary dyskinesia and bronchiectasis.[ncbi.nlm.nih.gov]

Workup

  • His workup revealed non-classic cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis (ABPA).[ncbi.nlm.nih.gov]
  • […] on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production (see Clinical), and characteristic radiographic findings on CT scans, such as bronchial wall thickening and luminal dilatation (see Workup[emedicine.medscape.com]
X-Ray Abnormal
  • Radiographic patterns may differ depending on the underlying disease; bronchiectasis due to cystic fibrosis develops predominantly in the upper lobes, whereas bronchiectasis due to an endobronchial obstruction causes more focal x-ray abnormalities.[merckmanuals.com]

Treatment

The major goals of therapy in dealing with bronchiectasis are as follows [9]:

  • Improvement of symptoms
  • Reduction of complications
  • Control of exacerbations
  • Reduction of morbidity and mortality

Early recognition is very important when dealing with bronchiectasis and other related conditions. Also, the management of underlying conditions is very important in the overall treatment of the condition. This may include the use of intravenous immunoglobulin or intravenous alpha1-antitrypsin (AAT) therapy.

Antibiotics as well as chest physiotherapy are very important parts of modalities. Other modalities are:

Patients with severe exacerbations of this condition can be treated on admission with a combination of these therapies.

Prognosis

Given the difficulty in identifying prevalence and the lack of definitive studies, it is fairly difficult to estimate current mortality [6]. Generally though, prognosis for patients with bronchiectasis is good. However, it varies based on the type of underlying or predisposing condition. Bronchiectasis associated with cystic fibrosis has the worst form of prognosis.

Etiology

There are many etiologic factors for bronchiectasis. Some of them are [3]:

Epidemiology

The documentation for this condition is poor around the world so it makes it difficult to have definitive figures for the incidence [4]. However, it is estimated that the condition affects 1 in 100,000 people.

There is no racial or sexual predilection as well.

Sex distribution
Age distribution

Pathophysiology

Bronchiectasis refers to an abnormal dilation of the proximal and medium-sized bronchi [5]. It is often caused by the weakening or destruction of the muscular and elastic components of the bronchial walls. Affected areas may also show a variety of changes which may include transmural inflammation, edema, scarring as well as ulceration. The distal lung parenchyma is also prone to damage following persistent microbial infection or frequent postobstructive pneumonia. Bronchiectasis may be congenital but most of the time it is acquired.

Congenital bronchiectasis most of the time affects infants and children. These cases are as a result of developmental arrest of the bronchial tree.

Acquired forms of these is seen in adults or older children and often require an infectious insult, impairment of drainage, airway obstruction as well as a defect in host defence.

Prevention

The main way to prevent the development of bronchiectasis is to avoid smoking or drop the habit [10]. Individuals struggling with dropping the habit can be put on tobacco cessation programs as soon as possible.

Occupational exposure to chemical fumes and dust is another common cause of development of this condition. People who work with this kind of lung irritant should take precautionary measures to protect themselves such as the use of respiratory protective equipment.

Summary

Bronchiectasis is a pulmonary disorder that usually occurs following some type of infection [1]. The condition is rare and results in a permanent distortion of parts of the airways [2]. The disorder is marked by inflamed and easily collapsible airways, obstruction of airflow as well as shortness of breath and an incapability of clearing out secretions within the airways. In some cases hemoptysis can occur while the more severe cases can lead to respiratory failure. The ailment was first recorded in 1819 by Laennec, but over time the prevalence, and treatment of bronchiectasis has changed.

Patient Information

Bronchiectasis is an incurable chronic lung condition where the wall of the airway of your lungs become damaged, losing their ability to clear out mucus. As mucus builds up, bacteria have a favourable environment to grow in and this brings about repetitive lung infections that can bring damage to your airways.

Since the airways are responsible for the delivery of oxygen and expelling of mucus, this condition has serious consequences most of the time. Heart failure, abscess in the brain or even a collapsed lung are some examples of the consequences.

References

Article

  1. Goyal V, Grimwood K, Marchant J, Masters IB, Chang AB. Does failed chronic wet cough response to antibiotics predict bronchiectasis?. Arch Dis Child. Feb 12 2014.
  2. Tiddens HA. Chest computed tomography scans should be considered as a routine investigation in cystic fibrosis. Paediatr Respir Rev. Sep 2006;7(3):202-8. 
  3. Young K, Aspestrand F, Kolbenstvedt A. High resolution CT and bronchography in the assessment of bronchiectasis. Acta Radiol. Nov 1991;32(6):439-41.
  4. Smith IE, Flower CD. Review article: imaging in bronchiectasis. Br J Radiol. Jul 1996;69(823):589-93.
  5. Chalmers JD, McHugh BJ, Docherty C, Govan JR, Hill AT. Vitamin-D deficiency is associated with chronic bacterial colonisation and disease severity in bronchiectasis. Thorax. Jan 2013;68(1):39-47. 
  6. Barker AF. Bronchiectasis. N Engl J Med 2002; 346:1383.
  7. Weycker, D, Edelsberg, J, Oster, G, Tino, G. Prevalence and economic burden of bronchiectasis [obstructive airways disease]. Clin Pulm Med 2005; 12:205.
  8. Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142:432.
  9. Loukides S, Bouros D, Papatheodorou G, et al. Exhaled H(2)O(2) in steady-state bronchiectasis: relationship with cellular composition in induced sputum, spirometry, and extent and severity of disease. Chest 2002; 121:81.
  10. Silva JR, Jones JA, Cole PJ, Poulter LW. The immunological component of the cellular inflammatory infiltrate in bronchiectasis. Thorax 1989; 44:668.

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Last updated: 2019-07-11 21:58