Bronchiectasis Genesis and its Association to Disease Severity

Bronchiectasis is a chronic lung disorder in which the bronchial tubes are permanently damaged, enlarged, and thickened compromised air passageways enable germs and mucus to accumulate and lodge in the lungs and lead to repeated infections and airway obstructions. Bronchiectasis is not curable; however, it is treatable. With therapy, patients may typically lead normal lives.

The prevalence of bronchiectasis rises with age, with a difference of 8 to 10 times greater beyond the age of 60 (300 to 500 per 100,000) than between ages 40 to 50 (40 to 50 per 100,000). Such pronounced age inequalities are mentioned in reports from Germany and the United Kingdom. An annual prevalence of 701 per 100,000 people was found in the Medicare (age 65 years) study of pulmonary specialty-recorded diagnosis. Women are more likely to have it than men.

Symptoms:

Symptoms of bronchiectasis might take months or even years to manifest. A few typical signs and symptoms include:

• A persistent, daily cough
• Daily production of copious volumes of thick mucus, and foul-smelling phlegm
• Breathlessness (dyspnea)
• Weird noises coming from breathing or gasping while breathing
• Coughing up blood (Hemoptysis)
• Swollen fingers with bent nails (nail clubbing)
• Chest ache
• Chronic respiratory infections
• Fatigue

Exacerbation signs include:

• Excessive weariness (fatigue)
• Fever and chills
• Worsening of breathlessness.
• Sweats during the night.

Causes of Bronchiectasis:

Bronchiectasis may be caused by any kind of lung damage. This disorder is classified into two types:

1. Cystic fibrosis (CF) bronchiectasis: Having CF, a genetic disorder that results in abnormal mucus production, is associated with this kind. Affected organs by CF include the liver, pancreas, and lungs. As a consequence, the lungs get infected repeatedly, which may lead to bronchiectasis.
2. Non-CF bronchiectasis: This kind has nothing to do with cystic fibrosis. The following are the most prevalent recognized illnesses that may cause non-CF bronchiectasis:
3. Prior severe respiratory infections, such as pneumonia or TB
4. Allergic bronchopulmonary aspergillosis (ABPA)
5. Chronic obstructive pulmonary disease (COPD)
6. Severe asthma
7. Primary ciliary dyskinesia
8. Primary or secondary immunodeficiency

Diagnosis:

A doctor should be seen immediately if any of the aforementioned symptoms last more than a week or if the patient has a chronic cough that produces a lot of mucus. The more quickly bronchiectasis is identified and treated, the less harm will be done to the lungs. Physical exam and analysis of the patient's medical history can help doctors identify bronchiectasis. Imaging examinations to look at pulmonary architecture may be advised if a doctor detects bronchiectasis or another lung condition. When bronchiectasis is suspected, the following tests may be done to confirm the diagnosis or rule out other possible causes:

• CT Scan: To check for damaged airways, the doctor uses a machine to take photos of the lungs.
• To determine infection, the doctor may order some specific blood tests and sputum cultures.
• Lung function tests are used to assess how well the lungs are functioning.
• To examine for genetic disorders, doctors could draw samples of blood or other bodily fluids.
• A sweat test will be done if there is suspicion of cystic fibrosis. The doctor will make the arm or leg sweat, take a sample, and check it for cystic fibrosis symptoms.
• Sometimes doctors may perform a procedure to examine the airways more precisely (bronchoscopy). They will locate and remove anything obstructing airways while collecting samples of mucus or pus from the lungs for testing using a bronchoscope, a long, flexible tube with a light, and a camera at the end.

The doctor will recommend medicine for treating the symptoms after receiving confirmation. In most cases, bronchiectasis patients may expect to live as long as those who do not have it receive the right care.

Tips for controlling bronchiectasis include:

• Stick to the bronchiectasis treatment plan.
• Take the drugs exactly as directed.
• Consume a nutritious, well-balanced diet.
• Consume plenty of water and other nonalcoholic drinks.
• Stick to a mild workout programme.
• Maintain proper sleep hygiene.
• Get a flu vaccination every year.
• Get a COVID-19 immunization and booster shot.
• Thoroughly wash your hands.
• Practice breathing methods and exercises.
• Keep proper posture.

References:

1. Seitz AE, Olivier KN, Adjemian J, et al. Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 2012; 142:432.

2. Henkle E, Chan B, Curtis JR, et al. Characteristics and Health-care Utilization History of Patients with Bronchiectasis in US Medicare Enrollees With Prescription Drug Plans, 2006 to 2014. Chest 2018; 154:1311.

3. Quint JK, Millett ER, Joshi M, et al. Changes in the incidence, prevalence and mortality of bronchiectasis in the UK from 2004 to 2013: a population-based cohort study. Eur Respir J 2016; 47:186.

4. Ringshausen FC, Rademacher J, Pink I, et al. Increasing bronchiectasis prevalence in Germany, 2009-2017: a population-based cohort study. Eur Respir J 2019; 54.

5.      Hough A. Physiotherapy in Respiratory and Cardiac Care: an evidence-based approach. 4th ed. Hampshire: Cengage Learning EMEA, 2014.

6.      Bronchiectasis. (2020).

lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis

7.      Bronchiectasis. (2022).

nhlbi.nih.gov/health-topics/bronchiectasis

8.      Koser U, et al. (2017). What’s new in the management of adult bronchiectasis?

f1000research.com/articles/6-527/v1

9.      Lonni S, et al. (2015). Etiology of non-cystic fibrosis bronchiectasis in adults and its correlation to disease severity.

ncbi.nlm.nih.gov/pmc/articles/PMC5467084/