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Bronchiectasis

Idiopathic bronchiectasis


Presentation

The clinical manifestations typical with bronchiectasis are cough and daily mucopurulent production of sputum which may last from months to years [7]. Blood-streaked sputum or hemoptysis may be as a result of airway damage following acute infection. Less specific symptoms include dsypnea, pleuritic chest pain, weight loss, wheezing and fever.

Dry bronchiectasis which is a rare variant of the condition manifests as episodic hemoptysis which has little-to-no production of sputum. Dry bronchiectasis is as a result of tuberculosis and is equally found in the upper lobes.

Bronchiectasis is a morphologic diagnosis and therefore, it can also exist with very little presentations.

Fever
  • Owing to recurrent fevers and post obstructive pneumonias, a lobectomy or rigid bronchoscopic removal were considered but the patient was deemed not to be a candidate for general anaesthesia due to her comorbidities.[ncbi.nlm.nih.gov]
  • Here we report the case of a 37 year-old man presenting to the emergency room with dyspnea, fever and cough; he developed respiratory failure requiring mechanical ventilation.[ncbi.nlm.nih.gov]
  • Symptoms are chronic cough and purulent sputum expectoration; some patients may also have fever and dyspnea. Diagnosis is based on history and imaging, usually involving high-resolution CT, though standard chest x-rays may be diagnostic.[msdmanuals.com]
  • 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]
  • 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]
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]
  • 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]
  • 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]
  • […] approved by the working group as: a person with bronchiectasis with a deterioration in three or more of the following key symptoms for at least 48 h: cough; sputum volume and/or consistency; sputum purulence; breathlessness and/or exercise tolerance; fatigue[ncbi.nlm.nih.gov]
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]
  • We present a rare complication of locally invasive XGP extending beyond the diaphragm to the lung to cause bronchiectasis in an adolescent girl with chronic productive cough, weight loss and no urinary symptoms.[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]
  • Loss Fitness Food & Cooking Parenting Pregnancy Sex & Relationships Skin & Beauty Men's Health Home Balance Diet & Weight Loss Fitness Food & Cooking Parenting Sex & Relationships Children's Health Home Fitness Food & Cooking Parenting Pregnancy Health[web.archive.org]
Anemia
  • This case study describes a 77-year-old female with bronchiectasis who presented with anemia, hypertension, hemothorax, and a mediastinal mass.[ncbi.nlm.nih.gov]
  • You’ll likely need a complete blood test to look for infection and anemia.[healthline.com]
  • Shortness of breath Bad breath Fits of coughing brought on by a change in posture, such as lying down Frequent respiratory infections Abnormal chest sounds Fatigue Appetite loss, weight loss, clubbed fingers, fever, and anemia in more advanced cases Prevention[healthcommunities.com]
  • In advanced cases the sputum and breath may become foul-smelling, and the patient may suffer loss of appetite, anemia, fever, episodes of pneumonia, and a general lowering of resistance to infection.[medical-dictionary.thefreedictionary.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
  • Objective 24-h cough, health status (cough-specific: Leicester Cough Questionnaire LCQ and bronchiectasis specific: Bronchiectasis Health Questionnaire BHQ), cough severity and lung function were measured.[ncbi.nlm.nih.gov]
  • 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]
  • RESULTS: Treatment with flutter resulted in greater displacement in a simulated cough machine and smaller contact angle, comparing the results between the first week (9.94 3.12 cm and 26.5 3.21 , respectively) and fourth week of treatment (13.96 5.76[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.[nhlbi.nih.gov]
Chronic Cough
  • It is increasingly identified during investigations into chronic cough and is evident high resolution CT scanning.[ncbi.nlm.nih.gov]
  • We report a 26-year-old male with TEF that presented with chronic cough. An x-ray carried out for the patient showed upper lobe bronchiectasis and massive esophageal dilatation.[ncbi.nlm.nih.gov]
  • 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]
  • 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[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[doi.org]
Sputum Production
  • Inhaled steroids may have a role in the management of bronchiectasis by reducing cough and sputum production.[ncbi.nlm.nih.gov]
  • Sputum production and pathogen isolation in sputum may indicate the presence of bronchiectasis which seems to contribute to the severity of asthma. 2017 John Wiley & Sons Ltd.[ncbi.nlm.nih.gov]
  • In non-CF bronchiectasis chronic infection with Pseudomonas aeruginosa is common and favored by the persistent local inflammation and viscid sputum production.[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[ncbi.nlm.nih.gov]
  • Sputum production, exacerbations and age, but not lung function, were independent predictors of cough frequency. Ambulatory objective cough monitoring provides novel insights and should be further investigated as an outcome measure in bronchiectasis.[ncbi.nlm.nih.gov]
Hemoptysis
  • RATIONALE: 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.medscape.com]
  • Blood-streaked sputum or hemoptysis may be as a result of airway damage following acute infection. Less specific symptoms include dsypnea, pleuritic chest pain, weight loss, wheezing and fever.[symptoma.com]
Purulent Sputum
  • CLINICAL PRESENTATION AND INTERVENTION: A 70-year-old woman presented with shortness of breath and increased production of purulent sputum.[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[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[doi.org]
  • Symptoms are chronic cough and purulent sputum expectoration; some patients may also have fever and dyspnea. Diagnosis is based on history and imaging, usually involving high-resolution CT, though standard chest x-rays may be diagnostic.[msdmanuals.com]
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]
Arm Claudication
  • While awaiting angiography, she developed left arm claudication and a pericardial effusion. Angiography revealed evidence of Takayasu arteritis and absence of flow in the left subclavian artery.[ncbi.nlm.nih.gov]
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]
  • 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]

Workup

In the standard scenario, bronchiectasis is suspected on the basis of the clinical presentation, mostly following a case where purulent sputum as well as other conditions such as pneumonia and lung abscess has been ruled out [8]. To further strengthen clinical suspicion, a sputum analysis is often used.

CT scanning is often used to confirm the diagnosis. As soon as diagnosis is confirmed, additional laboratory testing may be used to determine the underlying cause of the condition. Even though most causes of bronchiectasis are untreatable, identification of the treatable conditions is very important. In a specific percentage of patients, there is no readily identifiable cause detected. The choice of laboratory tests often varies and should be tailored to the individual patient as well as the clinical situation. The standard criterion however, for diagnosis of bronchiectasis is high resolution CT scanning (HCRT).

Pseudomonas
  • KEYWORDS: Bronchiectasis; MALDI-TOF MS; Pseudomonas monteilii; Pseudomonas putida; RAPD[ncbi.nlm.nih.gov]
  • Plasma fibrinogen was associated with bronchiectasis severity in two cohorts, Pseudomonas colonisation and health status, and offers potential as a useful biomarker. Crown Copyright 2017. Published by Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • KEYWORDS: Bronchiectasis; Ciprofloxacin; Dry powder inhaler; Nanoparticles; Pseudomonas aeruginosa[ncbi.nlm.nih.gov]
  • Bronchoscopy revealed Pseudomonas aeruginosa in bronchoalveolar lavage and bronchial secretions cultures. Eradication therapy led to clinical improvement.[ncbi.nlm.nih.gov]
  • In non-CF bronchiectasis chronic infection with Pseudomonas aeruginosa is common and favored by the persistent local inflammation and viscid sputum production.[ncbi.nlm.nih.gov]

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:

  • Bronchodilators
  • Corticosteroid therapy
  • Dietary supplementation
  • Oxygen or surgical therapies

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: 2018-06-22 10:06