What is Bronchiectasis (Lung Inflammation)?
Bronchiectasis, a long-term lung disease first described in the early 19th century, causes the bronchial airways in the lungs to permanently widen and weakens their self-cleaning mechanism. This weakening happens due to repeated infections that lead to more bacteria and mucus gathering in the bronchial tubes. Bronchiectasis causes a serious decrease in lung function and can lead to serious health problems, even potentially early death.
What Causes Bronchiectasis (Lung Inflammation)?
In the past, it was believed that the most common reason for bronchiectasis, a lung condition where the breathing tubes get permanently widened, was an infection in the respiratory system, commonly in childhood. We now know that its causes can be idiopathic (we don’t know why), acquired (it developed over time), or related to infections.
These infections could be bacterial and may include bacteria such as Mycobacterium, ones responsible for tuberculosis and atypical infections, Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus, Mycoplasma, and HIV.
Viral infections, such as the respiratory syncytial virus and measles, could also cause bronchiectasis. There’s also a risk of fungal infections leading to bronchiectasis.
A blockage in the bronchial tubes, for example, due to a foreign object, a plug of mucus, tumors, or swollen lymph nodes in the chest (known as hilar lymphadenopathy) can also lead to bronchiectasis.
Conditions like continuous aspiration of food or stomach acid into the lungs, chronic sinusitis, and injury from inhaling harmful substances can cause post-inflammatory pneumonitis, another contributor to bronchiectasis.
Genetically-linked or congenital conditions like cystic fibrosis, Young syndrome, primary ciliary dyskinesia (also known as Kartenger Syndrome), immunodeficiency, Alpha1-antitrypsin deficiency, and Mounier-Kuhn syndrome, can also cause bronchiectasis.
Inflammatory diseases such as ulcerative colitis, rheumatoid arthritis, and Sjögren syndrome can lead to bronchiectasis too.
Lung conditions like asthma, bronchomalacia, chronic obstructive pulmonary disease (COPD), diffuse panbronchiolitis, and idiopathic pulmonary fibrosis can also cause bronchiectasis.
An altered immune response can cause bronchiectasis. This could be due to conditions like allergic bronchopulmonary aspergillosis or hypersensitivity pneumonitis.
Lastly, yellow nail syndrome, a condition in which the nails turn yellow, the person develops lymphedema (swelling in the limbs), and flu-like symptoms, could also lead to bronchiectasis. This particular link to bronchiectasis was first described in 1964.
Risk Factors and Frequency for Bronchiectasis (Lung Inflammation)
Bronchiectasis is a lung condition, and it’s still not clear why it’s more common in some people than others. Worldwide, the number of people with this condition seems to have gone up in recent years. It can happen at any age, yet most cases used to be seen in children, before antibiotics were available. Recent data suggests that women and older people may be more likely to get bronchiectasis, leading to an increased demand for healthcare services.
Signs and Symptoms of Bronchiectasis (Lung Inflammation)
Bronchiectasis is a condition characterized by a lingering cough that produces mucus. It’s common for patients to experience a series of lung infections requiring antibiotics over a period of years. Symptoms may also include increasing difficulties with breathing, occasional wheezing, coughing up small amounts of blood, sharp chest pain, along with fatigue and weight loss. The small traces of blood are usually found in the mucus a patient coughs up and in rare cases, can be potentially life-threatening. Diagnosis generally occurs after many years of symptoms, when the chronic cough or coughing of blood become unbearable.
Here are the percentage of patients with particular symptoms:
- Cough: 98%
- Sputum (Mucus coughed up): 78% – typically thick and generally doesn’t smell
- Dyspnea (Difficulty breathing): 62%
- Haemoptysis (Coughing up blood): 56% to 92%
- Pleuritic chest pain (Chest pain when you take a deep breath in): 20% – Usually secondary to chronic coughing.
Overall, findings from physical exams are not specific. However, patients could show signs like:
- Digital clubbing (enlargement of fingers and toes): 2% to 3%
- Cyanosis (bluish color of the skin due to low oxygen levels)
- Plethora (having too much blood)
- Weight loss and a general wasting away of the body
During a chest exam, a doctor might hear:
- Crackles: 75% (sounds heard in the lung due to fluid), usually at the base of both lungs.
- Wheezing: 22% (high-pitched whistling sounds while breathing), may be due to blockage from secretions
Some patients with bronchiectasis might have underlying conditions that could present additional symptoms:
- Connective tissue diseases: Arthritis Sicca syndrome
- ABPA: Noticeable wheezing
- Bronchial obstruction: localized wheezing
- PCD, CF, Young Syndrome: Frequent sinus infections, fertility issues
The signs of an acute exacerbation (or flare-up) of bronchiectasis could include changes in mucus production, increased difficulties with breathing, heightened coughing, fever, more wheezing, and reduced lung function.
Testing for Bronchiectasis (Lung Inflammation)
The British Thoracic Society (BTS) recommends several tests when looking for underlying issues related to bronchiectasis. These tests involve different types of immunoglobulin levels, specific tests to rule out ABPA (a condition related to a certain type of fungal infection), sputum culture to check for certain bacteria, and screening for other diseases like cystic fibrosis. Some specific tests like the Alpha-1 Antitrypsin level, Ciliary function analysis, and HIV serology may be recommended in certain cases.
In terms of imaging, a chest X-ray is usually the first step when suspecting bronchiectasis. The X-ray can show certain signs like the thickening and abnormal dilation of bronchial walls. It can also show signs of complications, such as abnormalities due to mucus build-up and scarring.
While a chest X-ray can reveal some information, a CT scan can offer more details. A high-resolution CT scan can give a specific pattern that can narrow down the possible causes of the disease. In the CT scan, bronchial dilation, which is a hallmark of bronchiectasis, can be characterized by a larger broncho arterial ratio, lack of bronchial tapering, and visibility of airways near the lung periphery or mediastinal pleural surface.
The CT scan can show different patterns like cylindrical, signet-ring, varicose, and cystic or saccular. It can also show a mosaic lung attenuation, which is a term used to describe differences in lung tissue density due to damaged lung segments. In addition, the scan can reveal dilated bronchial arteries, especially when contrast is added. These irregular vessels are often the cause of blood in the sputum (hemoptysis).
Besides, a CT scan may also point to other findings like lobar collapse and mycetoma formation which refers to a certain type of fungal growth. This fungal ball is a major source of hemoptysis as well.
Decreased lung function is another sign of bronchiectasis. Certain measurements like the FEV1 and residual volume in lung function tests can show this. In bronchiectasis, FEV1 is usually decreased while the residual volume is increased indicating the presence of air trapping.
Treatment Options for Bronchiectasis (Lung Inflammation)
Bronchiectasis is a condition one can manage, but curing it is rarely possible. The primary goals of treating this condition are to identify and treat its cause, improve mucus clearance from the lungs, control infections, and reverse airway obstructions.
The first step in handling bronchiectasis is to find the cause and treat it accordingly. This could involve different treatments such as immunoglobulin replacement, steroids, or medication for underlying conditions like cystic fibrosis or fungal infections. Doctors typically recommend all patients get tested for potential causes.
The second step is to improve tracheobronchial clearance, meaning to clear mucus from the lungs. This could be done through postural drainage, which is adopting a position that allows the upper lung to drain, usually done for around 5 to 10 minutes twice a day. Other techniques include deep breathing followed by sharp exhales and “percussion” or tapping on the chest wall to help loosen mucus. These can prevent repeated infections and reduce coughing.
The third part of treatment entails controlling infections. The choice of antibiotic is usually based on culture results and sensitivity tests. However, if no specific bacteria are identified, then oral antibiotics such as amoxicillin can be sufficient for treating mild cases. Certain bacteria might require targeted antibiotic therapy sometimes by injection. Pseudomonas infections, for example, are treated with two weeks of intravenous antibiotics or inhaling a specific type of antibiotic over several months.
The fourth treatment goal is to reverse any blockages in the airway. This could involve inhaled treatments like bronchodilators and corticosteroids. Keeping a healthy lifestyle, such as quitting smoking and getting vaccinated for influenza and pneumococcal disease, also benefits patients with bronchiectasis.
Surgery is rarely the first choice for treating bronchiectasis but for some severe or complicated cases it might be necessary. These cases usually involve younger patients where the bronchiectasis is only affecting one side or specific areas of their lungs. In rare circumstances, severe bronchiectasis can lead to a lung transplant.
Emergencies like heavy bleeding from the lungs are also treated with procedures like bronchial artery embolization or surgery.
What else can Bronchiectasis (Lung Inflammation) be?
When dealing with certain respiratory symptoms, doctors might have to consider various conditions that could be causing them. Here are some of the disorders that they might take into account:
- Alpha 1 antitrypsin deficiency: A disease that can affect the lungs and liver
- Aspiration pneumonitis and pneumonia: Conditions caused by inhaling substances into your lungs
- Asthma: A chronic condition that makes it hard to breathe
- Bronchitis: An inflammation of your bronchial tubes
- Chronic obstructive pulmonary lung disease: A lung disease causing breathing issues
- Cystic Fibrosis: A hereditary disease that affects the lungs and digestive system
- Emphysema: A lung disease causing shortness of breath
- Gastroesophageal reflux disease: A digestive disorder that can lead to severe heartburn
- Tuberculosis: A potentially serious infectious disease that mainly affects your lungs
These diseases have overlapping symptoms so doctors need to carefully evaluate each case to make the right diagnosis.
