Bronchiectasis is a chronic lung disease characterized by frequent coughing, excessive sputum production, and bleeding in the mouth, which we call hemoptysis.

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Although bronchiectasis is as common as COPD and asthma, there is not enough information about which drugs are effective in the treatment and which patients benefit from surgery. So what is Bronchiectasis, how is it treated, and is it chronic? What is the role of surgery in the treatment of bronchiectasis? Here are the answers about bronchiectasis.

While bronchiectasis may be congenital, past infections (such as measles, tuberculosis), immune system disorders, foreign bodies entering the trachea during childhood, or some rare benign bronchial tumors (such as polyps and carcinoids) may cause bronchiectasis.

Congenital bronchiectasis (%15)

  • Tracheobronchomegaly, bronchomalacia, pulmonary sequestrations
  • Ultrastructural Defects (Kartagener syndrome, Young Syndrome)
  • Metabolic Defects (cystic Fibrosis, Alpha-1 Antitrypsin deficiency, immotile cilia syndrome)

Acquired bronchiectasis (%75)

  • Bronchopulmonary Infections(60%) (Measles, tuberculosis, and some infections)
  • Tracheal obstruction /Due to Bronchial Obstruction
    • Foreign bodies swallowed in childhood
    • Benign endobronchial tumors
    • Enlarged lymph nodes pressing on the bronchi from the outside
    • In these cases, a bronchoscopy should be performed.
  • COPD
  • Immune disorder
  • Inflammatory bowel diseases (Crohn, Ulcerative Colitis)
  • Recurrent aspiration pneumonia and lipoid pneumonia

What is Bronchiectasis?

Bronchiectasis is a disease characterized by enlargement and permanent damage in the bronchi and bronchial tubes due to the destruction of the elastic tissue and muscular structure in the bronchial walls of the lungs due to infection or inflammation.

The unhealthy air passage results in bacteria and microbes passing into the lungs over time, causing various problems. Bacteria accumulate in the lungs, causing infections and airway blockages. This condition is called bronchiectasis.

There is no definitive treatment for bronchiectasis because bronchial enlargement occurs irreversibly during this process. However, it is possible to manage and control the disease. For this, regular and controlled treatment is essential.

In obstructive lung diseases such as bronchiectasis, COPD, and asthma, airway narrowing increases airway resistance, especially during exhalation. It increases the workload of the respiratory muscles. Like COPD, decreased exercise tolerance, increased perception of shortness of breath, and skeletal muscle weakness occur in bronchiectasis. As the disease progresses, shortness of breath develops over time. For this reason, patients should be regularly checked by a Chest Diseases Specialist.

Diagnosis in Bronchiectasis

  1. Clinic
  • Productive cough
  • Abundant foul-smelling sputum (especially in the morning) (500 ml>)
    • Mild <15 cc/day,
    • Medium 15-150 cc/day,
    • Serious >150 cc/day
  • Bad breath
  • Hemoptysis
  • Fever
  • Weakness
  • Shortness of breath
  • Developmental delay in children
  1. Radiology
    • PA Chest X-ray
    • Thorax CT / HRCT
      • The diagnosis of bronchiectasis is made clearly
  1. Bronchoscopy
    • Tracheal obstruction /Due to Bronchial Obstruction
      • Foreign bodies swallowed in childhood
      • Benign endobronchial tumors
      • Enlarged lymph nodes pressing on the bronchi from the outside
bronşektazi cerrahisi
Figure 1: Bronchiectasis image on PA chest X-ray

How Is Bronchiectasis Treated?

1. Medical treatment is the first choice.

There is no definitive treatment method for bronchiectasis, but specific procedures allow this disease to be controlled. If diagnosed early, treatment begins early, and infection and inflammation are kept to a minimum. In this case, damage to the lungs and bronchi is slowed and controlled. The surgical treatment gives definite results in appropriately selected cases of bronchiectasis. In addition, preventing respiratory tract obstructions is a priority in treatment. Common treatments for bronchiectasis include:

  • The most critical issue in treating patients with bronchiectasis is to be treated with appropriate antibiotics when the patient has an attack of bronchitis or pneumonia. A culture antibiogram from previously taken sputum is crucial for a proper antibiotic. It should be known which antibiotic is sensitive or resistant.
  • Use of antibiotics to prevent and treat infections
  • More important than treating these attacks in bronchiectasis is to take measures to prevent the patient from having a frequent recurrence. For this reason, patients should apply respiratory physiotherapy techniques explicitly designed for them daily.
  • Regular breathing exercises and chest physiotherapy help to clear the airways.
  • Pulmonary rehabilitation
  • Administration of mucolytic drugs: Use of sputum thinning drugs
  • Since the risk of lung infection is higher in patients with bronchiectasis, influenza (flu) and pneumococcal (pneumonia) vaccines reduce the likelihood of patients being affected.
  • Bronchodilators: Asthma medications
  • Spray: used for sinuses

However, if the bronchiectasis is limited to the lung, the damaged part of the lung must be surgically removed.

2. Indications for Surgical Treatment in Bronchiectasis

The surgical treatment gives definite results in selected cases of bronchiectasis. The definitive diagnosis is made after tomography and bronchoscopy in necessary cases; if the disease is located in a limited area of the lung (if it is localized in one lobe and not in the opposite lung), they benefit from surgery. Respiratory physiotherapy with antibiotic treatment is applied before surgical intervention, and smoking cessation is recommended.The following patients may benefit from surgery:

  • In localized bronchiectasis resistant to medical treatment
  • If bronchiectasis is localized only in one region, that is, in one lobe, and there is no bronchiectasis in another part of the lung
  • Location in a local area and repeatedly infected
  • Multiple hospitalizations in a year due to bronchiectasis infection
  • Those who produce a lot of sputum and bad breath and do not want medical treatment
  • Massive Hemoptysis (Bleeding)
  • Proximal airway obstruction
kistik bronşektazi

Figure 2: Bronchiectatic areas in both lungs on thorax CT. These two patients do not benefit from surgery because both lungs have bronchiectasis areas.

variköz bronşektazi

Figure 3.

Surgical Technique in Bronchiectasis

  • Lung resection with thoracoscopy/VATS
  • Lung resection with ROBOTIC surgery
  • Lung resection with thoracotomy/open surgery

3. Lung Transplant

Lung transplantation is a treatment option in patients with end-stage lung disease.

Bronchiectasis disease occurs with various symptoms. The most common symptoms of the disease are:

  • Chronic cough
  • Bloody saliva
  • Chest pain
  • Shortness of breath
  • Wheezing
  • Excessive expectoration
  • Weight loss
  • Weakness
  • Bad breath
  • Frequent respiratory infections
  • Developmental delay (in children)

Untreated bronchiectasis causes the patient to have more frequent attacks and more severe symptoms. In case of progression of the disease, an increase is observed in all complaints, such as blood in the sputum, shortness of breath, and coughing.

In addition, if the expansion of the bronchi is not intervened in time, this situation may not be reversed, and permanent structural defects occur as a result. The disease symptoms begin to recur at more frequent intervals. So the patient's general health becomes progressively worse. Inflammation spreads and covers a larger area, and regional destructions occur in the lung.

As a result, in excessively progressive bronchiectasis, breathing becomes no longer supported by the lungs, and respiratory failure develops. In some patients, long-standing bronchiectasis may lead to nutritional disorders, anemia, and bone diseases. Immediate intervention and regular control are vital for the condition.

If bronchiectasis is not eliminated, it progresses over time, leading to death. The most crucial factor here is early intervention of the disease and ensuring physician control by making appropriate life changes.

One of the critical issues in treating bronchiectasis is treating the patient with the appropriate antibiotic. Patients who have had a bronchitis attack should be treated with the right drugs. Detailed sputum examinations and examinations deemed appropriate by the physician should be performed to select the proper medicine. In addition, reducing the frequency of attacks in the patient is one of the main goals. For this, it is necessary to do sports as well as regular breathing exercises. Therefore, the patient can live a longer and healthier life. Consequently, it is essential to go to the doctor's control constantly to control the disease and intervene on time.

Bronchiectasis is a disease that develops due to inflammation or infection. It causes permanent bronchial dilatation, that is, enlargement in the airways due to the destruction of elastic tissue and muscle structures in the bronchial walls.

Briefly, this lung disease, which is defined as excessive enlargement of the bronchi, develops chronically and causes more complaints in the patient over time. The most common symptoms are profuse sputum production, coughing, and bleeding from the mouth. In obstructive lung diseases such as bronchiectasis, COPD, and asthma, airway narrowing increases airway resistance, especially during exhalation. It increases the workload of the respiratory muscles.

Early diagnosis and diagnosis are critical in the treatment of bronchiectasis. Thus, the disease can be kept under control before progressing much. However, in this case, the patient has essential duties.

The points that patients with bronchiectasis should pay attention to are:

  • If one or more of the symptoms are observed, it is necessary to consult a doctor immediately.
  • The doctor's recommendations should be followed in the treatment.Only the medications approved by the doctor should be used.A culture antibiogram in the previous sputum is very important
  • Breathing exercises should be done by consulting a physiotherapist.
  • Fever should be avoided.
  • Light-paced sports such as swimming and walking should be done regularly.
  • Consumption of yeast products such as beer, wine, and bread should be limited and, if possible, discontinued.
  • It is necessary to clear the inflammation in the bronchi at least twice a day (morning and evening).
  • Do not stay in air-conditioned and humid areas.
  • Sleep and eating habits need to be regulated.
  • Constantly communicate with your specialist physician. If any, conditions, such as pregnancy, should be decided together with the physician.
  • A culture antibiogram should be done before antibiotic use.
  • Morale and motivation should be kept high, and stress should be avoided.
  • Smoking should be stopped, and cigarette smoke should be avoided.
  • Regular use of vitamins is recommended as an additional treatment. It is necessary to consult a specialist physician for recommended vitamins.

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