Bronchiectasis: Dilation and Bracing of the Bronchi

Curated by Luigi Ferritto (1), Walter Ferritto (2)

Definition

The bronchiectasis are chronic dilations of the bronchi, of a size greater than 2 mm, due to the destruction of their walls; bronchiectasis can be congenital (ie present from birth) or acquired (ie caused by a disease, such as bronchitis, inflammation or other factors, such as old age or smoking habits). Congenital forms, very rare, are due to malformations or weakness of the walls of the bronchi. The acquired forms, on the other hand, derive from the destruction of the elastic component of the bronchi, caused by an infection.

Fifty percent and more of patients with bronchiectasis suffered in the past, generally in infancy, from bronchopulmonary diseases (bronchopneumonia, pertussis, tuberculosis). It should be noted, however, that chronic bronchial diseases, many of which lead to the obstruction of respiratory tracts, do not always and do not necessarily result in bronchiectasis, which is why it is necessary to admit the competition of unknown factors intrinsic to the bronchi, so that this morbid state can be realized . A fact which is not easy to explain is that sinusitis is present in most bronchiectasis.

Symptoms

To learn more: Symptoms Bronchiectasis

When the patient has symptoms similar to that of bronchitis, but hardly influenced by therapy, it is reasonable to think of a bronchiectasis. The main symptom is cough, especially in the morning, characterized by sputum rich in pus (a more or less liquid material formed by microbes and dead cells) and sometimes by blood. Respiratory infections are frequent, especially pneumonia, accompanied by fever, weight loss, tiredness and shortness of breath. With the evolution of the bronchiectasis process, pulmonary tissue destruction occurs, with areas of scarring and emphysema; consequently a state of pulmonary insufficiency takes place.

Diagnosis

The diagnosis should be suspected based on the symptoms described. The chest X-ray may be normal, while the bronchial changes are well evidenced with the high resolution chest tac. Bronchoscopy can be useful in the unilateral forms, to exclude the presence of tumors or foreign bodies, and in bilateral forms, to remove secretions and analyze their characteristics (microbiological and cytological examinations).

Therapy

Medical therapy aims to prevent infections and, in the case of exacerbations, to treat the isolated germs with microbiological examination of the sputum with broad-spectrum antibiotics. It is also necessary to avoid cigarette smoking and the inhalation of irritating substances. Respiratory gymnastics and bronchial dysstruction techniques may be useful, and when performed regularly they can facilitate the elimination of secretions. In more advanced forms, if an important hypoxemia occurs, it is necessary to start treatment with oxygen therapy to maintain adequate levels of oxygenation in the blood. In selected cases, especially in the monolateral and circumscribed forms, it is possible to resort to surgical resection of bronchiectasis. This surgical device is usually used with an urgency criterion in the case of massive pulmonary hemorrhage, in which the bleeding vessel is removed or embolized. The prognosis depends on the extent of the disease and the patient's response to medical therapy. It is usually ominous in the forms with diffuse bronchiectasis and which determine important hemoptysis.

In later stages lung transplantation may be considered.

For correspondence: Dott. Luigi Ferritto

Department of Internal Medicine Respiratory Physiopathology Unit "Athena" Villa dei Pini

Piedimonte Matese (CE)