Saturday, January 31, 2009

Bronchiectasis - how to manage it well

By Jason Croller

Bronchiectasis is a rare disease, which causes the airtubes in your lungs (bronchi) to become permanently misshapen. The airways are inflammed and collapse really easily. This makes it difficult for air to flow throught the tubes into your lungs. As a result you will feel breathless. You might also find it difficult to clear your secretions, so you cough more. Because the secretions don't drain properly, they become infected and so your cough tends to become productive. Your sputum is often greenish, but can become blood stained.

Bronchiectasis can be due to a plethora of causes. The most common is an infection, such an an obstructed pneumonia or whooping cough. Younger people are sometimes affected by a genetic condition, such as cystic fibrosis, which results in them suffering with bronchiectasis. Babies can even be born with it, if their lungs don't form properly in utero.

Before, when there weren't any immunisations or antibiotics it used to be much more common. Although it is probably under reported, the estimates suggest that only about 100 000 Americans have this condition at any one time.

The symptoms that you would have if you were unfortunate enough to have bronchiectasis would be a long history of a daily cough. You would probably be coughing up green muck from your chest. You may even have coughed up some blood.

Sometimes patients have less specific symptoms. They may present with difficulty breathing or sharp chest pain. They may wheeze. Some might simply be increasingly tired and losing weight.

Hopefully, your doctor will be suspecting this condition as a possibility. To help them work out what is wrong with you they will need to undertake some investigations. They may ask for some blood tests. They could organise for your sputum to be analysed by the microbiologist to see whether there is an infection there or not. They are likely to organise a chest x-ray and may well consider a chest CT scan.

Typically, bronchiectasis is a progressive condition. If it is allowed to progressed unchecked, it will result in worsening lung function, which may then lead to your heart being put under excess and perhaps excessive strain.

The goals of therapy are to improve your symptoms, diminish the chances of complications and manage any exacerbations.

Antibiotics and physiotherapy are the two mainstays of therapy. You also need to avoid tobacco smoke, improve your nutrition and diminish the chances of you developing additional investigations by getting immunised against influenza, pneumococcus, measles, german measles and whooping cough.

Sometimes your doctor may use inhalers, steroids and oxygen to help your lungs cope better. If you had an infection, your lung disease would get worse and so you should be admitted under a chest physician or pulmonologist for intravenous antibiotics.

Occaisionally, surgery is necessary, particularly if only part of your lung is affected by the disease. By cutting out the diseased portion of lung, it may be possible for you to feel and be better than by continually rescuing your diseased lung from flare up after flare up.

Sadly, bronchiectasis can not be cured, but it can be controlled. It requires the patient to carefully adhere to all of the therapy and work closely with the medical team - but it is possible to live well with bronchiectasis.

For more detailed advice you should contact your local respiratory unit - 15437

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