What is Bronchiectasis?
Bronchiectasis is the abnormal, permanent dilation of the upper airways of the lungs. The branches of airways, called bronchi, become progressively smaller until they reach the alveoli, which are numerous small sacks or air where the exchange of oxygen and carbon dioxide take place. Bronchiectasis only affects the elasticity of the smooth muscle and cellular wall of the larger upper airways.
This results in greater difficulty effectively clearing secretions from the lungs, which in turn leads to greater frequency of infection. This begins a cycle of further damage, inflammation, greater mucus production and retention, ultimately leading to more infections. Even the body’s own immune response can, under these conditions, add to the damage of the airways.
What causes Bronchiectasis?
There are numerous causes for bronchiectasis. However, in approximately 50% of cases, an underlying cause is not found.
Bronchiectasis may present as a primary lung manifestation of lung conditions, which can cause chronic inflammation resulting from an abnormality of anatomy, immunity or function.
These conditions include:
- Post infections such as pneumonia, tuberculosis, measles, influenza and whooping cough
- Immune Deficiency such as lung and bone marrow transplant. Malignancy and HIV/AIDS
- Cystic Fibrosis
- Pulmnonary Fibrosis
- Allergic aspergillosis (an allergic lung reaction to fungus)
- Bronchial obstruction such as inhalation of foreign objects, tumour, airway compression
- Inflammatory bowel disease
Secondary bronchiectasis is more common and may occur as a complication of other lung diseases as a consequence of airway distortion, traction and ultimate damage in relation to conditions including:
- COPD
- Emphysema
- Bronchitis
- Bronchiolotis
- Interstitial Lung disease
What are the symptoms of Bronchiectasis?
The most common symptoms are:
- Chronic cough
- sputum of various quantities
Some or all of the following symtoms may also be present:
- Recurring chest infections (exacerbations)
- Haemoptysis (coughing up blood)
- Chest pain
- Shortness of breath
- Wheeze
- Lethargy
- Exercise limitation
- Chronic sinus inflammation
- Gastro-oesophageal reflux
- Weight loss
- Vhange in the structure of fingernails and toenails, known as clubbing
How is Bronchiectasis diagnosed?
A doctor can confirm a diagnosis of Bronchiectasis following a detailed investigation of your symptoms, medical history and using specific tests to rule out other possible conditions. If you suspect you have Bronchiectasis you should seek an assessment with your doctor.
Tests may include:
- Sputum test to check your mucus for microorganisms such as viruses, fungi, or bacteria
- Chest X-Ray or CT Scan to provide images of your lungs
- Pulmonary Function Tests to find out how well air is flowing into your lungs
- QuantiFERON blood test or purified protein derivative skin test to check for tuberculosis
- Sweat test to screen for CF
Management of Bronchiectasis
There’s no cure for bronchiectasis, but treatment is important to help you manage the condition. The main goal of treatment is to keep infections and bronchial secretions under control.
It’s also critical to prevent further obstructions of the airways and minimize lung damage. Common methods of treating bronchiectasis include:
- Physiotherapy for clearing the airways
- Pulmonary Rehabilitation
- Medication – to thin the mucus and bronchodilators to open up the airways
- Antibiotics to prevent and treat infection
- Oxygen Therapy
- Vaccinations to prevent respiratory infections
At respiratory physiotherapy Ireland, our physiotherapists will complete a comprehensive assessment which will assist with the prescription of an appropriate, individualised management plan.
Treatment may include some of the following:
- Airway Clearance Techniques
- Active Cycle of Breathing
- Positive Expiratory Pressure (PEP)
- Oscillating (PEP)
- Autogenic drainage
- Postural Drainage
- Manual Therapy such as percussion and vibrations
- Exercise
- Inhalation Therapy
- Advice and education on correct nebuliser and/or inhaler regime
- Inhaler technique
- Exercise Assessment and Prescription
- Those experiencing dyspnoea on exertion (even mild dyspnoea) may benefit from a formal exercise program. A formal exercise program generally includes aerobic and resistance training. Exercise training includes intensity, frequency, duration, type, mode and progression based on the severity and type of bronchiectasis.
Summary
Early recognition of bronchiectasis is important so that intervention can begin before significant lung damage occurs. There is no cure for bronchiectasis, but it is manageable. With treatment, you can typically live a normal life. However, flare-ups must be treated quickly to maintain oxygen flow to the rest of your body and prevent further lung damage.
If you have been diagnosed by your doctor as having Bronchiectasis and are suffering from symptoms affecting your breathing and lung clearance, you would benefit from an assessment with one of our experienced respiratory physiotherapists.
For more information on how physiotherapy can help treat bronchiectasis or to book yourself an assessment, please contact us here at Respiratory Physiotherapy Ireland.
