Abnormal widening of the larger airways in the lungs (bronchi), causing a persistent cough with large amounts of sputum
- May begin in childhood but may not become apparent until after the age of 40
- In some cases, the underlying cause is inherited
- Gender and lifestyle are not significant factors
In bronchiectasis, the larger branches of the airways in the lungs (the bronchi) become abnormally wide, and their lining is damaged. Bronchiectasis usually starts in childhood as a result of a lung infection, but the symptoms of the disorder may not appear until after the age of 40. The main symptoms are a persistent cough that produces large amounts of sputum and shortness of breath that becomes progressively more severe. The disorder was once fairly common, but it is now rare in the developed world due to the greatly reduced incidence of childhood lung infections.
What are the causes?
Childhood infections such as whooping cough (see Pertussis) and measles were once very common causes of bronchiectasis. Today, the main cause is repeated bacterial infections of the lungs in people with the inherited condition cystic fibrosis, in which the mucus produced by the lining of the airways is thicker than normal and tends to collect in the lungs. The repeated infections damage the bronchi, which become distorted so that small pockets form in the tissue. Stagnant mucus then builds up in the pockets, where it may become infected. When the condition is confined to just one area of the lung it may be caused by a blockage in one of the bronchi, which may be due to an inhaled object, such as a peanut, or a tumour.
What are the symptoms?
The symptoms of bronchiectasis gradually worsen over a period of several months or years and may include:
A persistent cough that produces very large quantities of dark green or yellow sputum. The cough is often worse when lying down.
Coughing up blood.
Wheezing and shortness of breath.
Enlarged fingertips with abnormal fingernails, known as clubbing (see Nail abnormalities).
Eventually, an affected person will also experience the effects of long-term infection, such as weight loss and anaemia. Bronchiectasis may affect an increasing number of bronchi, causing extensive damage to a large area of the lung tissue, and may finally lead to respiratory failure.
How is it diagnosed?
Your doctor may suspect that you have bronchiectasis from the large amount of sputum that you cough up. Your sputum may be tested in order to identify an infection, and you may also have a chest X-ray and lung function tests. CT scanning may be used to assess airway damage.
What might be done?
If you have bronchiectasis, you should not smoke, and you should avoid smoky atmospheres and dust.
A family member or friend may be taught how to give you chest physiotherapy, which ideally should be carried out every day. This technique helps mucus to drain from the lungs. You lie on a bed or other flat surface with your head and chest hanging over the edge so that the mucus can drain into your windpipe. A relative or friend then taps your back with cupped hands to help to free the mucus in your lungs. Keeping the lungs as clear of mucus as possible reduces the risk of infections that may cause further lung damage.
You may be prescribed inhaled bronhodilator drugs or corticosteroid drugs (see Corticosteroids for respiratory disease) to help you to breathe more easily. If an infection develops, it will be treated with antibiotics. In severe cases, a lung transplant may be considered.
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.
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