What is Bronchiectasis?
Bronchiectasis is a disease of the lungs occurring as a result of partial or permanent destruction to one or more conducting bronchi or airways. This defect in bronchioles occurs after the previous infections to the lungs. The damage is seen in the smooth muscles present in the bronchial tubes. These smooth muscles of bronchial tubes play a very important role in the elasticity of tubes and prevent the secretion of lung tissue from being cleared up.
Due to recurrent inflammation of the airways (bronchial tubes) they collapse and this collapse causes difficult clearance of secretions (often with impaired cough) ultimately resulting in obstruction of airflow and shortness of breath. Sometimes blood in sputum (hemoptysis) is also seen.
In bronchiectasis, part of the lungs involved is one segment one sub-segment or a single lobe. Rarely there is the involvement of many sections of the lungs, but it occurs only when there is an association of other systemic diseases along with it such as CYSTIC FIBROSIS.
Is Bronchiectasis a Congenital Disease?
Bronchiectasis is rarely a congenital disease, most commonly it is an acquired disease due to regular exposure to chemicals in the environment.
Due to recurrent infections, the walls of bronchial tubes get fibrosis. As a result, the elastic component in the smooth muscles present in the walls of bronchial tubes is destroyed. Ultimately leading to the weakening of walls of the bronchial tube that leads to slow movements of tubes and therefore dilation of tubes.
Changes occurring in affected areas are seen as oedema, scarring, ulcerations, and transmural inflammation.
The final result of the destruction of bronchial walls is impaired dilation and not clearance of secretions.
These secretions then keep on accumulating in the lungs and when bacteria from outside enter the lungs they settle on these accumulations and grow.
After settlement on this, they colonize and start releasing toxins, these toxins destroy walls and purulent discharges are released. These discharges then become expectoration.
This cycle of damage continues and goes on with recurrent infections.
How to classify Bronchiectasis?
Three types are –
• Cylindrical bronchiectasis
• Cystic bronchiectasis
• Varicose bronchiectasis
Cylindrical bronchiectasis
In this type of bronchiectasis, there is the involvement of diffused mucosa (oedema) which results in changes in affected bronchiole as they become straight, with regular outlines and end squarely.
Cystic bronchiectasis
In this type, new vessels formed around the affected area are involved and ulcerations occur there. This result makes bronchioles appear balloon-shaped.
Varicose bronchiectasis
In this type, bronchioles are dilated, seen in dispersed sites of construction and sites of obstructive scars. This type complicates pneumonitis and parenchymal damage.
Who is more prone to Bronchiectasis?
-Bronchiectasis is once thought to be a disease of infants.
-It can occur in any age and any sex but is most common in older women.
What are the causes of bronchiectasis?
Bronchial obstruction
Bronchial obstruction can occur due to many factors such as bronchial stenosis from infection, Broncho lithiasis, endobronchial tumours, and foreign body aspiration. These causes lead to bronchiectasis. Right middle lobe syndrome is the major factor.
Primary infections
There are many organisms involved in primary infection of the lungs. Organisms are as follows:-
• Pertussis virus
• Measles virus
• Staphylococcus aureus
• Herpes simplex virus
• Nontuberculous mycobacteria
• Mycobacterium tuberculosis
• Mycoplasma pneumonia
Cystic fibrosis
This disease involves almost every organ of the body so it affects the lungs also and causes fibrosis of lung tissue, especially of bronchioles.
Young syndrome
Young syndrome presents three characteristic diseases bronchiectasis, sinusitis and obstructive azoospermia.
Bronchopulmonary allergic aspergillosis
In this disease immune system responds to Aspergillus antigen when inhaled and the reaction is bronchospasm and bronchiectasis.
Aspiration
After aspiration of foreign products or gastric material (peptic juices in cases of lungs, it leads to post-obstructive pneumonia that finally results in bronchiectasis.
Other causes are:-
• Sarcoidosis
• Relapsing polychondritis
• Systemic lupus erythematosus
• Sjogren syndrome
• Regular to external environmental polluted agents
What are the signs and symptoms of Bronchiectasis?
• Long history of a cough with a large amount of offensive sputum
• Fatigue
• Blood on coughing along with sputum
• Odour of breath
• Clubbing is seen in the fingers
• Paleness
• Breathing is short during exercise
• Wheezing
• Weight loss
On examination of the chest by a doctor with a stethoscope, it is found
Wheezing
Rattling
Bubbling
Clicking in the lower lobes of the chest
What investigations are advised in cases of Bronchiectasis?
• Culture of sputum
• Complete blood count(CBC)
• X-ray chest anterior-posterior view and lateral views
• Alpha 1 antitrypsin blood test
• Aspergillosis precipitin test
• CT scan of chest
• PPD skin test
• Serum immunological electrophoresis
What is the prognosis of Bronchiectasis?
The future of the disease depends upon the cause of bronchiectasis.
Many cases are treated but complications lead to disability.
What are the complications of Bronchiectasis?
• Repeated attacks of pneumonia.
• Blood in expectoration on coughing.
• Cor pulmonale.
• Oxygen levels are low in the blood.
What treatment is advised in cases of Bronchiectasis?
In acute cases of obstruction to airways and difficulty breathing relieving of air, the passage is most important.
Daily drainage of accumulated secretions is a must from the lungs.
Antibiotics are used in cases of fever with infection.
Bronchodilators are used in cases of difficulty in breathing.
What are the commonly indicated Homeopathic medicines for Bronchiectasis?
Antimonium tartaricum
Kali bich
Stannum metallicum
Hepar sulphur
Balsanum Peruvian
