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Bronchiectasis
Classification and external resources
ICD-10 J47., Q33.4
ICD-9 494, 748.61
DiseasesDB 1684
MedlinePlus 000144
eMedicine med/246
MeSH D001987

Bronchiectasis is a disease state defined by localized, irreversible dilation of part of the bronchial tree. It is classified as an obstructive lung disease, along with emphysema, bronchitis and cystic fibrosis. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis.[1]

Contents

History

Rene Laënnec, the man who invented the stethoscope, used his invention to first discover bronchiectasis in 1819.[2] The disease was researched in greater detail by Sir William Osler in the late 1800s; it is suspected that Osler actually died of complications from undiagnosed bronchiectasis.[3]

Causes

There are both congenital and acquired causes of bronchiectasis. Kartagener syndrome, which affects the mobility of cilia in the lungs,[4] aids in the development of the disease. Another common genetic cause is cystic fibrosis, in which a small number of patients develop severe localized bronchiectasis[5]. Young's syndrome, which is clinically similar to cystic fibrosis, is thought to significantly contribute to the development of bronchiectasis. This is due to the occurrence of chronic, sinopulmonary infections.[6] Patients with alpha 1-antitrypsin deficiency have been found to be particularly susceptible to bronchiectasis, for unknown reasons.[7] Other less-common congenital causes include primary immunodeficiencies, due to the weakened or nonexistent immune system response to severe, recurrent infections that commonly affect the lung.[8]

Acquired bronchiectasis occurs more frequently, with one of the biggest causes being tuberculosis. Endobronchial tuberculosis commonly leads to bronchiectasis, either from bronchial stenosis or secondary traction from fibrosis.[9] An especially common cause of the disease in children is acquired immune deficiency syndrome (AIDS), stemming from the human immunodeficiency virus (HIV). This disease predisposes patients to a variety of pulmonary ailments, such as pneumonia and other opportunistic infections.[10] Bronchiectasis can sometimes be an unusual complication of inflammatory bowel disease, especially ulcerative colitis. It can occur in Crohn's disease as well, but does so less frequently. Bronchiectasis in this situation usually stems from various allergic responses to inhaled fungus spores.[11] Recent evidence has shown an increased risk of bronchiectasis in patients with rheumatoid arthritis who smoke. One study stated a tenfold increased prevalence of the disease in this cohort[12]. Still, it is unclear as to whether or not cigarette smoke is a specific primary cause of bronchiectasis.

Other acquired causes of bronchiectasis involving environmental exposures include respiratory infections, obstructions, inhalation and aspiration of ammonia and other toxic gases, pulmonary aspiration, alcoholism, heroin (drug use), and various allergies.[13] It may also be the result of untreated allergic bronchopulmonary aspergillosis.[14]

Diagnosis

The diagnosis of bronchiectasis is based on the review of clinical history and characteristic patterns in high-resolution CT scan findings. Such patterns include "tree-in-bud" abnormalities and cysts with definable borders. In one small study, CT findings of bronchiectasis and multiple small nodules were reported to have a sensitivity of 80%, specificity of 87%, and accuracy of 80% for the detection of bronchiectasis. Bronchiectasis may also be diagnosed without CT scan confirmation if clinical history clearly demonstrates frequent, respiratory infections, as well confirmation of an underlying problem via blood work and sputum culture samples.[15]

Treatment

Treatment of bronchiectasis includes controlling infections and bronchial secretions, relieving airway obstructions, removal of affected portions of lung by surgical removal or artery embolization and preventing complications. This includes the prolonged usage of antibiotics to prevent detrimental infections[16], as well as eliminating accumulated fluid with postural drainage and chest physiotherapy. Surgery may also be used to treat localized bronchiectasis, removing obstructions that could cause progression of the disease.[17]

Inhaled steroid therapy that is consistently adhered to can reduce sputum production and decrease airway constriction over a period of time, and help prevent progression of bronchiectasis. One commonly used therapy is beclometasone dipropionate, which is also used in asthma treatment.[18] Use of inhalers such as albuterol (salbutamol), fluticasone (Flovent/Flixotide) and ipratropium (Atrovent) may help reduce likelihood of infection by clearing the airways and decreasing inflammation.[19]

Although not approved for use in any country, Mannitol dry inhalation powder, under the name Bronchitol, has been granted orphan drug status by the FDA for use in patients with bronchiectasis and with cystic fibrosis.[20]

Combination therapies, long acting bronchodilators and inhaled corticosteroids such as Symbicort and Advair Diskus are also commonly used inhaled medicines which has in many cases been effective in clearing the airways, reducing sputum and reducing inflammation.

Prevention

In order to prevent future development of bronchiectasis, an x-ray of the chest should be taken after any severe attack of measles, whooping cough or other acute respiratory infection in childhood. While smoking has not been found to be a direct cause of bronchiectasis, it is certainly an irritant that all patients should avoid in order to prevent the development of infections (such as bronchitis) and further complications.[21]

A healthy body mass index, vaccination (especially against pneumonia and influenza) and regular doctor visits may have beneficial effects on the prevention of progressing bronchiectasis. The presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent can greatly affect the mortality rate from this disease.[22]

See also

References

  1. ^ Hassan, Isaac (8 December 2006). "Bronchiectasis". eMedicine Specialties Encyclopedia. Gibraltar: WebMD. http://www.emedicine.com/radio/topic116.htm. Retrieved 2007-06-22. 
  2. ^ Roguin, A (2006). "Rene Theophile Hyacinthe Laënnec (1781–1826): The Man Behind the Stethoscope". Clin Med Res 4 (3): 230–35. 
  3. ^ Wrong O (2003). "Osler and my father". J R Soc Med 96 (6): 462–64. doi:10.1258/jrsm.96.9.462. PMID 12949207. 
  4. ^ Morillas HN, Zariwala M, Knowles MR (2007). "Genetic Causes of Bronchiectasis: Primary Ciliary Dyskinesia". Respiration 72 (3): 252–63. PMID 17534128. 
  5. ^ Dalrymple-Hay MJ, Lucas J, Connett G, Lea RE (1999). "Lung resection for the treatment of severe localized bronchiectasis in cystic fibrosis patients". Acta Chir Hung. 38 (1): 23–5. PMID 10439089. 
  6. ^ Handelsman DJ, Conway AJ, Boylan LM, & Turtle JR (1984). "Young's syndrome. Obstructive azoospermia and chronic sinopulmonary infections". NEJM 310 (1): 3–9. 
  7. ^ Shin MS, Ho KJ (1993). "Bronchiectasis in patients with alpha 1-antitrypsin deficiency. A rare occurrence?". Chest 104: 1384–86. doi:10.1378/chest.104.5.1384. 
  8. ^ Notarangelo LD, Plebani A, Mazzolari E, Soresina A, Bondioni MP (2007). "Genetic causes of bronchiectasis: primary immune deficiencies and the lung". Respiration + 74 (3): 264–75. doi:10.1159/000101784. PMID 17534129. 
  9. ^ Catanzano, Tara (5 September 2005). "Primary Tuberculosis". eMedicine Specialties Encyclopedia. Connecticut: WebMD. http://www.emedicine.com/radio/topic411.htm. Retrieved 2007-06-22. 
  10. ^ Sheikh S, Madiraju K, Steiner P, Rao M (1997). "Bronchiectasis in pediatric AIDS". Chest 112 (5): 1202–7. doi:10.1378/chest.112.5.1202. PMID 9367458. 
  11. ^ Ferguson HR, Convery RP (2002). "An unusual complication of ulcerative colitis". Postgrad. Med. J. 78: 503. doi:10.1136/pmj.78.922.503. PMID 12185236. 
  12. ^ Kaushik, VV, Hutchinson D, Desmond J, Lynch MP, and Dawson JK (2004). "Association between bronchiectasis and smoking in patients with rheumatoid arthritis". Annals of the Rheumatic Diseases 63: 1001–2. doi:10.1136/ard.2003.015123. PMID 15249329. 
  13. ^ Lamari NM, Martins ALQ, Oliveira JV, Marino LC, Valério N (2006). "Bronchiectasis and clearence physiotherapy: emphasis in postural drainage and percussion" (in Portuguese). Braz. j. cardiovasc. surg. 21 (2). 
  14. ^ Allergic Bronchopulmonary Aspergillosis
  15. ^ Miller, JC (2006). "Pulmonary Mycobacterium Avium-Intracellular Infections in Women". Radiology Rounds 4 (2). 
  16. ^ Evans DJ, Bara AI,Greenstone M (2007). "Prolonged antibiotics for purulent bronchiectasis in children and adults". Cochrane Database Syst Rev (2): CD001392. doi:10.1002/14651858.CD001392.pub2. PMID 17443506. 
  17. ^ Otgün I, Karnak I, Tanyel FC, Senocak ME, Büyükpamukçu N (2004). "Surgical treatment of bronchiectasis in children". J. Pediatr. Surg. 39 (10): 1532–6. PMID 15486899. http://linkinghub.elsevier.com/retrieve/pii/S0022346804004026. 
  18. ^ Elborn JS, Johnston B, Allen F, Clarke J, McGarry J, Varghese G. (1992). "Inhaled steroids in patients with bronchiectasis". Respir Med 86 (2): 121–4. doi:10.1016/S0954-6111(06)80227-1. PMID 1615177. 
  19. ^ Reports, Consumer (15 March 2007). "Ipratropium and Albuterol Inhalation - Drug Review". Consumer Reports of U.S.. http://www.consumerreports.org/mg/drug-reports/ipratropium-and-albuterol-inhalation.htm. Retrieved 2007-06-22. 
  20. ^ Waknine, Yael (27 July 2005). "Orphan Drug Approvals: Bronchitol, Prestara, GTI-2040". Medscape today for WebMD. http://www.medscape.com/viewarticle/509116. Retrieved 2007-06-22. 
  21. ^ Crofton J (1966). "Respiratory tract disease. Diagnosis and treatment of bronchiectasis. I. Diagnosis". Br Med J 1 (5489): 721–3 contd. PMID 5909486. 
  22. ^ Onen ZP, Eris Gulbay B, Sen E, Akkoca Yildiz O, Saryal S, Acican T, Karabiyikoglu G (2007). "Analysis of the factors related to mortality in patients with bronchiectasis". Respir Med. 101 (7): 1390–97. doi:10.1016/j.rmed.2007.02.002. PMID 17374480. 

External links


1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

BRONCHIECTASIS (Gr. 13p6'yxca, bronchial tubes, and rcraals, extension), dilatation of the bronchi, a condition occurring in connexion with many diseases of the lungs. Bronchitis both acute and chronic, chronic pneumonia and phthisis, acute pneumonia and broncho-pneumonia, may all leave after them a bronchiectasis whose position is determined by the primary lesion. Other causes, acting mechanically, are tracheal and bronchial obstruction, as from the pressure of an aneurism, new growth, &c. It used to be considered a disease of middle age, but of late years Dr Walter Carr has shown that the condition is a fairly common one among debilitated children after measles, whooping cough, &c. The dilatation is commonly cylindrical, more rarely saccular, and it is the medium and smaller sized tubes that are generally affected, except where the cause is mechanical. The affection is usually of one lung only. Emphysema is a very common accompaniment. Though at first the symptoms somewhat resemble those of bronchitis, later they are quite distinctive. Cough is very markedly paroxysmal in character, and though severe is intermittent, the patient being entirely free for many hours at the time. The, effect of posture is very marked. If the patient lie on the affected side, he may be free from cough the whole night, but if he turn to the sound side, or if he rises and bends forward, he brings up large quantities of bronchial secretion. The expectoration is characterized by its abundance and manner of expulsion. Where the dilatation is of the saccular variety, it may come up in such quantities and with so much suddenness as to gush from the mouth. It is very commonly foetid, as it is retained and decomposed in situ. Dyspnoea and haemoptysis occasionally occur, but are by no means the rule. If pyrexia is present, it is a serious symptom, as it is a sign of septic absorption in the bronchi, and may be the forerunner of gangrene. If gangrene does set in, it will be accompanied by severe attacks of shivering and sweating. Where the disease has lasted long, clubbing of fingers and toes is very common. The diagnosis from putrid bronchitis is usually fairly easily made, but at times it may be a matter of extreme difficulty to distinguish between this condition and a tuberculous cavity in the lung. Nothing can be done directly to cure this disease, but the patient's condition can be greatly alleviated. Creosote vapour baths are eminently satisfactory. A mechanical treatment much recommended by some of the German physicians is that of forced expiration.


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