Bronchiectasis: Causes, Symptoms, and Treatment Options with a Real-Life Case

Introduction

Bronchiectasis is a chronic, irreversible lung disease characterized by the permanent dilatation of the bronchial airways. This structural lung damage impairs mucociliary clearance, making patients more susceptible to recurrent chest infections. Individuals with bronchiectasis experience various symptoms, including a chronic, usually productive cough, wheezing, shortness of breath, pleuritic chest pain, and recurrent chest infections, with or without fever, depending on the infection's severity.

Diagnosis of bronchiectasis is made based on these symptoms combined with radiological evidence of structural bronchial dilatation, which is typically cystic. Treatment for bronchiectasis involves identifying and addressing the underlying cause and preventing recurrent flare-ups. Vaccinations and lifestyle modifications also play a crucial role in preventing recurrent chest infections.

Causes

The most common cause of bronchiectasis is a chest infection, often occurring in childhood. These infections can be:

• Bacterial: Mycobacterium tuberculosis, Hemophilus influenza, Pseudomonas, Staphylococcus aureus, and Streptococcus pneumonia.

• Viral: Measles, respiratory syncytial virus.

• Fungal: Aspergillus and Candida species.

Other potential causes include a foreign body in the bronchial tree, mucus plug impaction, compression of the bronchial tree by tumors or lymph nodes, chronic aspiration, chronic sinusitis, and gastroesophageal reflux disease.

Symptoms

Patients with bronchiectasis present with varying symptoms depending on the severity of their condition and any active infection.

• Cough: This is the most common symptom. Impaired mucociliary clearance leads to mucus accumulation in the dilated bronchi, irritating the lungs and causing a cough with expectoration.

• Hemoptysis: Chronic inflammation and infection can damage the bronchial walls, leading to coughing up blood. Sometimes, bronchial artery involvement can cause massive hemoptysis, potentially requiring bronchial artery embolization.

• Wheezing: Chronic bronchial wall inflammation, scarring, and narrowing, along with impaired mucociliary clearance, contribute to wheezing in patients with bronchiectasis.

• Dyspnea (Shortness of Breath): Loss of lung function due to chronic inflammation and infection, reduced elasticity, mucus secretion, and obstruction are reasons for dyspnea in bronchiectasis.

• Pleuritic Chest Pain: This type of chest pain in bronchiectasis is often due to inflammation in the pleura (the lining around the lungs).

• Recurrent Chest Infections: These are common due to structural lung damage and impaired mucus clearance, which create favorable conditions for pathogens to thrive.

• Unintentional Weight Loss: This can occur due to increased energy expenditure from recurrent infections and reduced oral intake.

Diagnostic Work-up

• Chest Radiograph (X-ray): This is the initial imaging study for patients suspected of having bronchiectasis. A chest X-ray can reveal details like circular rings, opacities, and air-fluid levels.

• Computed Tomography (CT) Scan: A CT scan of the chest is highly sensitive for diagnosing bronchiectasis. Multi-detector computed tomography (MDCT) is the preferred method, but high-resolution computed tomography (HRCT) can also be used if MDCT is unavailable. Classically, in bronchiectasis, airways are visible within 1 cm of the pleural space, with a bronchoalveolar ratio (BAR) greater than one.

Management

Management of bronchiectasis focuses on identifying the underlying cause, ensuring better infection control, and utilizing chest exercises to improve mucus clearance. In cases of infection, mucus cultures should be taken to guide appropriate antibiotic selection. Patients with bronchiectasis must also be vaccinated.

Role of Ayurveda

Ayurveda and Yoga can be very helpful for patients with bronchiectasis. Various Rasayanas in Ayurveda work to improve overall lung health and immunity. Patients receiving Ayurvedic treatment may experience fewer acute exacerbations and infections, and it may also minimize the need for steroids. Please note: Specific Ayurvedic drugs are not mentioned here to prevent self-medication; these should always be taken under the supervision of a qualified Ayurvedic physician.

Several Yoga asanas promote better lung health and are highly effective in increasing mucus clearance. These include:

• Dhanurasana (Bow Pose)

• Urdhva Dhanurasana (Wheel Pose)

• Urdhva Mukha Svanasana (Upward-Facing Dog)

• Setubandhasana (Bridge Pose)

• Ustrasana (Camel Pose)

• Bhujangasana (Cobra Pose)

• Matsyasana (Fish Pose)

Case Presentation

A 34-year-old male presented with a cough associated with fever for three days, accompanied by difficulty breathing. He had been receiving treatment from a local chemist. A careful history revealed recurrent chest infections, and he also reported a history of pulmonary tuberculosis in childhood.

General Physical Examination: He was conscious, alert, and febrile at the time of examination. His blood pressure was 100/60 mm Hg, pulse rate 128 beats/minute (regular), temperature 102°F, and respiration rate 20 breaths/minute. Bilateral crackles were noted on chest auscultation.

Diagnostic Workup: His total leukocyte count was significantly elevated (22,000). A chest radiograph showed consolidation in the right middle lobe along with multiple ring shadows in both lung fields.

Image 1. Showing consolidation in the right middle lobe along with multiple ring shadows in both lung fields.

Contrast-Enhanced Computed Tomography (CECT) of the chest revealed central cystic bronchiectatic changes involving all lobes in both lung fields, with a predominance of a few cysts showing dependent air-fluid levels. Airways were also visible close to the pleural space.

Image 2. Showing central cystic bronchiectatic changes involving all lobes in both lung fields, with a predominance of a few cysts showing dependent air-fluid levels.

Management: In view of sepsis, the patient was managed at a tertiary care center for acute infection control and to determine the underlying cause of his condition.

Conclusion

Bronchiectasis is a challenging chronic lung condition that significantly impacts a patient's quality of life due to recurrent infections and respiratory symptoms. Early diagnosis, comprehensive management targeting both the underlying cause and symptom control, and adherence to preventative measures like vaccinations are crucial. Integrating complementary approaches like Ayurveda and Yoga, under professional guidance, can further enhance lung health and reduce the frequency of exacerbations. While there is no cure, a holistic approach can help patients manage their condition effectively and improve their overall well-being.