Bronchiectasis

Bronchiectasis are pathological and irreversible enlargements of the bronchi, which are primarily due to infectious diseases and are associated with recurrent (recurring) respiratory diseases. With the vaccination and antibiotic therapies available today, bronchiectasis is rarely diagnosed.

What are bronchiectasis?

Constrictions of the bronchi by foreign bodies, tumors in the bronchial area or enlarged lymph nodes (in the case of lymph node tuberculosis) can lead to bronchiectasis.
© Henrie - stock.adobe.com

Bronchiectasis is an abnormal cylindrical or sac-shaped enlargement of the bronchi that is irreversible. In the bronchi, there is a disorder of the mucociliary apparatus (self-cleaning system of the bronchi) due to an increasing deposition of bronchial secretions (bronchial mucus) as a result of a recurrent respiratory or infectious disease.

As a result, those affected by bronchiectasis have a chronic cough with expectoration rich in mucus. Since the bronchial secretion is difficult to cough up and the removal from the bronchial expansions is severely restricted, it accumulates there and promotes the colonization and reproduction of bacteria. Those affected by bronchiectasis are accordingly more susceptible to infectious diseases.

causes

In bronchiectasis, a distinction is made between acquired and congenital forms. In the case of congenital bronchiectasis, the disease can be attributed to impaired differentiation of the alveoli (alveoli), structural anomalies of the cilia (cilia that ensure the removal of bronchial secretions) or genetic diseases such as alpha-1 antitrypsin deficiency or cystic fibrosis (cystic fibrosis) .

Since there is a disorder of the mucociliary apparatus in these diseases, the removal of the bronchial secretions is severely restricted, so that bronchiectasis can develop in the further course. Acquired bronchiectasis, which makes up the majority of cases, often results from recurrent respiratory diseases such as chronic bronchitis or pneumonia and from infectious diseases such as tuberculosis, measles or whooping cough, especially if these occur in childhood.

Constrictions of the bronchi by foreign bodies, tumors in the bronchial area or enlarged lymph nodes (in the case of lymph node tuberculosis) can lead to bronchiectasis. In idiopathic bronchiectasis, the disease cannot be traced back to any cause.

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Symptoms, ailments & signs

Bronchiectasis primarily causes a strong cough, which is associated with mucous sputum. The secretions have a sweet, putrid smell and are often streaked with blood or pus. The purulent sputum can be noticed especially in the morning.

As a result of the chronic inflammation and suppuration of the bronchi, other symptoms such as fever or shortness of breath occur in addition to the damp cough. Chronic oxygen deficiency manifests itself in watch glass nails, drumstick fingers and a decrease in physical and mental performance. In individual cases bacterial infections of the bronchi and lungs occur.

In the worst case, pronounced pneumonia occurs, which manifests itself as acute breathing difficulties, severe pain and an increasing feeling of illness. The lungs are also more susceptible to fungal infections and purulent encapsulation. If the bacteria enter the brain through the bloodstream, a brain abscess can develop.

This manifests itself, for example, in neurological failure symptoms, headaches and unconsciousness. Bronchiectasis mostly forms on the small to medium-sized bronchi. They can be recognized by the typical reddening of the bronchi. In addition, the bronchi are much more sensitive to pain, and touching them leads to acute reactions such as nausea and sweating.

Diagnosis & course

In bronchiectasis, an initial suspicion is based on the typical chronic cough with sputum. Furthermore, rattling and whistling noises (wheezing) can be heard when listening to the bronchi.

Various other examinations can be performed to confirm the diagnosis of bronchiectasis. The pathogen can be determined by analyzing the blood and sputum. An EKG (electrocardiogram) can be used to check whether the heart muscle is already impaired (right heart failure). The diagnosis is confirmed by x-rays and an HRCT (high-resolution computed tomography) of the lungs, which can be used to detect bronchiectasis.

In addition to a chronic cough and repeated infectious diseases, bronchiectasis also causes fever, fatigue and hemoptysis (coughing up blood). If left untreated, bronchiectasis can lead to heart failure. If bacteria spread to other parts of the body via the blood, there is a risk of a brain abscess (purulent inflammation).

In order to avoid further complications (obstructive bronchitis, pneumothorax), a consistent and adequate therapy is essential.

Complications

In bronchiectasis, the sac-shaped enlargements of the bronchi lead to damage to the bronchial walls over time. As a result, the bronchi expand permanently and tend to partially hold back the continuously produced, slimy secretion. The result is a vicious circle of recurring infections.

In addition, fungal colonization of the enlarged bronchial vessels can occur, with the formation of fungal colonies (aspergillomas). In bronchiectasis, the following complications are known such as pulmonary bleeding, lung abscesses, brain abscesses, collapse of a lung (pneumothorax) and pneumonia. Chronic obstructive bronchitis is one of the dreaded complications.

The increase in pressure in the lungs often results in permanent overloading of the right ventricle (cor pulmonale). Pulmonary hypertension leads to right heart failure with the following symptoms: swelling of the liver with pain under the right costal arch, jaundice and the formation of edema, especially in the legs. Right heart failure threatens as a life-threatening consequence of right heart failure.

Effective treatments reduce the symptoms of bronchiectasis and prevent irreversible consequential damage. When a complication occurs, it adversely affects the course of the disease. With the introduction of modern antibiotic therapies, complications that were often seen in the past have become rare. In addition, good prevention is important.

When should you go to the doctor?

If typical symptoms such as long-lasting irritable cough or recurrent coughing attacks with purulent sputum occur, a doctor must be consulted. Medical clarification is necessary at the latest in the case of coughing up blood, fatigue and attacks of fever. Bronchiectasis is not always present, but at least a serious disease of the lungs and throat that needs to be diagnosed and treated.

If bronchitis and pneumonia occur repeatedly, an immediate doctor's visit is recommended. In the event of shortness of breath or cardiovascular problems, an emergency doctor must be alerted. In the further course it can come to drumstick fingers, watch glass nails and similar symptoms. These external signs are a reason for a quick medical evaluation. Patients with chronic lung disease, bronchial asthma, tuberculosis, or whooping cough should see a doctor with unusual symptoms.

Patients with cystic fibrosis or Kartagener's syndrome are particularly prone to bronchiectasis and should speak to their doctor as soon as the first signs of the lung disease appear. If the pathological expansions are recognized at an early stage, they can be treated successfully and usually without complications.

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Treatment & Therapy

If the bronchiectasis can be clearly localized, the affected tissue can be surgically removed (surgical resection). In particularly severe cases, a lung transplant may be necessary.

In addition, bronchiectasis is usually treated conservatively. Antibiotic therapy is an essential component in avoiding bacterial colonization and spreading into the lungs and other areas of the body. The infectious agents can be tested for antibiotic resistance using an antibiogram. In addition, mucolytics (expectorants) can be used to dissolve the bronchial secretions in the affected areas, and cortisone inhalers can be used to reduce an inflammatory reaction.

Another essential component of the therapy of bronchiectasis are physiotherapeutic measures, with the help of which a cleaning of the bronchial tubes from bronchial secretions as well as an optimization of the performance should be promoted. Those affected by bronchiectasis learn breathing exercises to avoid dry coughing (lip brake), techniques to encourage the coughing of bronchial secretions (drainage, huffing, inhalation) and to relieve shortness of breath (breathing and relaxation techniques such as the driver's seat).

In order to improve the general performance of the bronchi, regular sporting activities that support the respiratory muscles (lung sport) are recommended in the case of bronchiectasis, depending on the functionality of the lungs and heart of the person affected by bronchiectasis.

Outlook & forecast

In most cases, bronchiectasis leads to a positive course of the disease. The bronchiectasis can be removed by surgery, which completely alleviates the symptoms. However, they can also be combated with the help of antibiotics if their spread is not too high.

In the worst case, the affected person is dependent on a lung transplant. If the bronchiectasis is not treated, the symptoms worsen and the infection spreads to other areas of the body. In the worst case, this can lead to death of the person concerned. There is a shortage of breath and thus significant restrictions in the life and everyday life of the patient. However, the bronchiectasis can occur again even after successful treatment, so that a new treatment is necessary.

Especially people with a weak immune system and people of old age can be severely affected by the symptoms of this disease. After the treatment, various breathing exercises are usually necessary to fully restore the function of the lungs. If treatment is successful, the patient's life expectancy will not be reduced.

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prevention

Although there are no preventative measures for bronchiectasis, a healthy lifestyle (healthy diet, regular exercise, quitting smoking) can help strengthen the immune system and protect against infectious diseases and respiratory infections. Influenza and pneumococcal vaccinations provide additional protection for the body and can prevent further complications from bronchiectasis.

Aftercare

In most cases, the options for follow-up care for bronchiectasis are severely limited or hardly possible at all. The affected person is dependent on permanent therapy, since the disease cannot be treated completely. In some cases, the symptoms can also lead to the death of the person affected or significantly reduce the life expectancy of the patient.

Since the disease is treated with the help of antibiotics in most cases, it is important to ensure that the medication is taken regularly. Antibiotics should also not be taken together with alcohol, so alcohol should be avoided during the entire therapy. The person concerned should also refrain from smoking and in general from taking nicotine in order to protect the lungs.

Even strenuous activities or sporting activities should always be avoided with this disease so as not to unnecessarily burden the body. In severe cases, however, the person concerned has to have a lung transplant in order not to significantly reduce life expectancy. A healthy lifestyle with a healthy diet also have a positive effect on the course of the disease. Furthermore, contact with other sufferers of this disease can also prove to be useful.

You can do that yourself

For bronchiectasis, there are various home remedies and self-help methods. Bed rest and rest are particularly recommended as a support for drug or surgical treatment. In order to avoid further coughing attacks and lung pain, attention should also be paid to a diet that is gentle on the lungs. Irritating foods should be avoided for some time after the treatment. Healthy foods such as fruits, vegetables and whole grains should be a permanent part of the diet.

In the first time after an operation, medicinal plants can be used against coughs and pain. Anise, lungwort, myrtle and thyme have proven themselves. These remedies can be drunk either as tea or in the form of compresses and compresses on the neck and neck. Schüssler salts and other homeopathic preparations can also be used, but should be used in consultation with the responsible doctor.

The disease should be completely cured in order to prevent the bronchiectasis from spreading. The throat and pharynx in particular should always be kept warm. Those affected should also drink a lot and eat slowly. If, despite these measures, further complaints arise, a doctor must be consulted.