Bronchiectasis usually the result of damage to airways


Dear Doctor: I am 72 years old and have bronchiectasis, which I understand is a form of COPD. Can you give me some more information about it? I’ve never been in a smoking environment, but I was raised in a home that used coal and wood for heat.

Dear Reader: Although bronchiectasis and chronic obstructive pulmonary disease, or COPD, are related, they are actually two separate conditions. COPD is an umbrella term for a number of airway diseases, such as chronic bronchitis and emphysema, which obstruct air flow in the lungs and leave the person short of breath. Bronchiectasis causes similar problems, but it is considered a distinct diagnosis of its own.

As the name suggests, bronchiectasis is a disease of the bronchial tubes, or bronchi. These are the main airways into the lungs. When you inhale, the breath moves through the larynx and descends through the trachea, or windpipe. At that point, the airway divides into a pair of bronchi, which are sturdy but flexible mucus-lined tubes made up of cartilage and smooth muscle. These bronchial tubes direct the inhaled breath to the left and right lungs. Each bronchial tube continues to divide and subdivide into ever-smaller structures, the whole of which is referred to as the bronchial tree. As the bronchi become smaller, the proportion of smooth muscle increases and cartilage decreases. This makes them more flexible but less sturdy. The bronchial tree culminates in a variety of tiny tubes, or tubules, and saclike structures, which handle the exchange of oxygen and carbon dioxide.

In someone living with bronchiectasis, chronic inflammation has caused the bronchial tubes to become scarred, thickened and widened. The damage leaves them slack and loose, which interferes with the proper movement of mucus. This leads to the buildup of mucus, as well as buildup of the inhaled particles, dust and bacteria that the mucus is meant to capture and clear away. The result is repeated lung infections, which further damage the structures of the lung and make it more difficult to breathe.

Elizabeth Ko, MD and Eve Glazier, MD

The most common cause of bronchiectasis is damage to the airways. This can be from severe pneumonia, whooping cough, tuberculosis or fungal infections. Cystic fibrosis, a genetic disease that causes a buildup of mucus in the lungs, is related to half the cases of bronchiectasis in the U.S. Allergic reactions to certain fungi and diseases of the connective tissue, including rheumatoid arthritis and Crohn’s disease, are also known to play a role. You mentioned extended exposure to smoke from wood and coal; studies have linked both wood smoke and coal dust to the condition.

Although there is no cure for bronchiectasis at this time, it can be managed. Treatment includes the use of bronchodilators to expand the airways, medications to thin mucus and expectorants to make it easier to cough up. For lung infections, antibiotics are the primary course of treatment. Chest physical therapy, a specific technique that uses percussive force on the chest and back, helps to loosen accumulated mucus. The goals of the combined therapies are to loosen and remove mucus and prevent or cure resulting infections.

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