Bronchiectasis: Symptoms, Diagnosis and Treatment



0:00 Introduction
0:24 Causes of Bronchiectasis
1:06 Symptoms of Bronchiectasis
1:34 Diagnosis of Bronchiectasis
2:42 Treatment of Bronchiectasis
3:15 Prevention of Bronchiectasis

Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung.[5] Symptoms typically include a chronic cough with mucus production.[3] Other symptoms include shortness of breath, coughing up blood, and chest pain.[2] Wheezing and nail clubbing may also occur.[2] Those with the disease often get lung infections.[8]

Bronchiectasis may result from a number of infectious and acquired causes, including measles,[11] pneumonia, tuberculosis, immune system problems, as well as the genetic disorder cystic fibrosis.[12][3][13] Cystic fibrosis eventually results in severe bronchiectasis in nearly all cases.[14] The cause in 10–50% of those without cystic fibrosis is unknown.[3] The mechanism of disease is breakdown of the airways due to an excessive inflammatory response.[3] Involved airways (bronchi) become enlarged and thus less able to clear secretions.[3] These secretions increase the amount of bacteria in the lungs, resulting in airway blockage and further breakdown of the airways.[3] It is classified as an obstructive lung disease, along with chronic obstructive pulmonary disease and asthma.[15] The diagnosis is suspected based on symptoms and confirmed using computed tomography.[7] Cultures of the mucus produced may be useful to determine treatment in those who have acute worsening and at least once a year.[7]

Periods of worsening may occur due to infection.[8] In these cases, antibiotics are recommended.[8] Common antibiotics used include amoxicillin, erythromycin, or doxycycline.[16] Antibiotics, such as erythromycin, may also be used to prevent worsening of disease.[3][17] Airway clearance techniques, a type of physical therapy, are also recommended.[18] Medications to dilate the airways and inhaled steroids may be used during sudden worsening, but there are no studies to determine effectiveness.[3][19] There are also no studies on the use of inhaled steroids in children.[19] Surgery, while commonly done, has not been well studied.[20][3] Lung transplantation may be an option in those with very severe disease.[9]

The disease affects between 1 per 1000 and 1 per 250,000 adults.[10] The disease is more common in women and increases as people age.[3] It became less common since the 1950s with the introduction of antibiotics.[10] It is more common among certain ethnic groups (such as indigenous people in the US).[10] It was first described by René Laennec in 1819.[3] The economic costs in the United States are estimated at $630 million per year.[3]
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