WHAT IS BRONCHIECTASIS

Bronchiectasis is a condition characterised by damage to the airways causing them to widen and become flabby and scarred.

Bronchiectasis usually occurs as a result of an infection or any other condition that injures the walls of your airways or prevents the airways from clearing mucus which is a slimy substance that helps remove inhaled dust, bacteria, and other small particles.  In bronchiectasis, airways slowly lose their ability to clear out mucus which later builds up and creates an environment in which bacteria can grow, which ultimately leads to serious and repeated lung infections. With every infection, there is more damage to the airways. Over time, airways lose their ability to help inhale and exhale, which prevents adequate oxygen from reaching the vital organs.

There are very many causes which account for bronchiectasis. However, in approximately 50% of cases, an underlying cause is not found. In these cases, the disease is often found in the lower lobes. It is likely though that “idiopathic”.

Bronchiectasis sometimes presents as a primary lung manifestation because of the conditions listed below, which may cause chronic inflammation resulting from an abnormality of anatomy, immunity or function.  The more common form, Secondary Bronchiectasis may occur as a complication of lung diseases as a consequence of airway traction, distortion and damage about conditions including bronchitis, bronchiolitis, COPD, emphysema,  and interstitial lung disease.

Post-infection:

• Pneumonia
• Pertussis (whooping cough)
• Viral (measles, adenovirus, influenza virus)
• Mycobacterial (tuberculosis and atypical NTM)

Primary or secondary immune deficiency:

• Immunoglobulin G subclass deficiency – for more information go to Immune Deficiency Foundation
• Hypogammaglobulinemia
• Lung and bone marrow transplantation
• Malignancy
• HIV/AIDS
• Human T-Lymphotropic Virus 1 (HTLV-1)
  Asthma and fungal allergy
• Allergic bronchopulmonary aspergillosis (ABPA)

Mucociliary dysfunction:

• Cystic Fibrosis
• Primary Ciliary Dyskinesia
• Kartagener’s Syndrome

Recurrent small volume aspiration:

• Gastroesophageal reflux
• Poor dentition/recurrent oral infection

Bronchial obstruction:

• Inhalation of foreign objects such as peanuts
• Tumour
• Airway compression
• Lymph node

Systemic inflammatory diseases:

• Rheumatoid arthritis
• Sjögren’s Syndrome
• Inflammatory bowel disease
• Sarcoidosis

Structural lung disease:

• Chronic obstructive pulmonary disease
• Bronchiolitis

Interstitial lung disease

• Pulmonary fibrosis and pneumoconiosis
• Silicosis

Miscellaneous

• Alpha-1 Antitrypsin Deficiency
• Yellow Nail Syndrome

Treatable causes of bronchiectasis:

• Immune deficiency
• ABPA
• Mycobacterial infection
• Airway obstruction
• Inflammatory bowel disease
• Rheumatoid arthritis
• Aspiration

The initial airway damage begins in childhood that leads to bronchiectasis. However, signs and symptoms do not appear until months or even years until after you start having repeated lung infections.  The most common indicated signs and symptoms of bronchiectasis are:

• Shortness of breath and wheezing (a whistling sound when you breathe)
• Chest pain
• Clubbing (the flesh under your fingernails and toenails gets thicker)
• A daily cough that occurs over months or years
• Daily production of large amounts of sputum, which you cough up and spit out, may contain trapped particles, mucus and pus.

Over time, you may have more serious symptoms. You may cough up blood or bloody mucus and feel very tired. Children report weight loss or may not grow at a normal rate.

Bronchiectasis frequently is treated with medicines, hydration etc.. Doctors recommend surgery if the bronchiectasis is isolated to a section of lung or you have a lot of bleeding.

If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen therapy.

The goals of treatment are to:

• Treat any underlying conditions and lung infections.
• Remove mucus (a slimy substance) from your lungs. Maintaining good hydration helps with mucus removal.
• Prevent complications.
• Early diagnosis and treatment of the underlying cause of bronchiectasis may help prevent further lung damage.

Medicines

Doctors usually prescribe antibiotics, expectorants, bronchodilators or mucus-thinning medicines to treat bronchiectasis.

• AntibioticsThe main treatment for the repeated lung infections that cause bronchiectasis is Antibiotics.Oral antibiotics often are used to treat these infections.

• Expectorants and Mucus-Thinning Medicines
  
  Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus. Expectorants help loosen the mucus in your lungs. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.

Hydration

Hydrating yourself with plenty of liquids, especially water, helps prevent airway mucus from becoming thick and sticky.

Oxygen Therapy

Oxygen therapy helps to raise low blood oxygen levels. For this treatment, one receives oxygen through a mask or nasal prongs Oxygen therapy can be done at home, in a hospital, or care-24 health facility.

Surgery

Your doctor may recommend surgery if no other treatments have helped and only one part of your airway is affected. Your doctor may recommend surgery if you have major bleeding in your airway,  to control bleeding or to remove a part of your airway.

HOW CAN PHYSIOTHERAPY FOR BRONCHIECTASIS HELP?

Chest physiotherapy for bronchiectasis (bronchiectasis physiotherapy)

CPT is also called physiotherapy or chest clapping or percussion. Generally, a respiratory therapist performs this technique but can be done by a trained member of the family. It involves the therapist pounding your chest and back over and over with his or her hands or a device. Doing this helps loosen mucus from your lungs so you can cough it up.  You can sit with your head tilted down or lie on your stomach with your head down while you do CPT. Force and gravity help to drain mucus from the lungs. Some people find CPT hard or uncomfortable to do.

Several devices can help with chest physiotherapy for bronchiectasis, such as:

• A Mechanical percussor also is known as an electric chest clapper.
• An inflatable therapy vest that uses high-frequency airwaves to force mucus toward your upper airways so you can cough it up.
•  A handheld device that helps to breathe out through, producing vibrations that dislodge the mucus.
• A mask that too produces vibrations to help break loose mucus from your airway walls.

Some of these methods and devices are popular with patients and doctors, but little information is available on how well they work.  Several breathing techniques also are used to help move mucus to the upper airway so it can be coughed up.

The purpose of physiotherapy treatment for bronchiectasis is to improve exercise tolerance, reduce symptoms of dyspnoea and fatigue and improve quality of life. Bronchiectasis physiotherapist may also assist in clearing secretions.

For individuals with bronchiectasis, the minimal requirements for exercise training are 30 minutes of moderate intensity workout, 3 times per week.

Aerobic training

Walking (ground-based or treadmill), cycling, swimming or rowing are options.

Resistance/strength training

Lower limb: Functional activities (Squats, stairs, sit to stand, step ups)  Equipment required: leg press, quadriceps extension Upper limb: hand-held weights (dumbbells) pull-down, pectoral press.

Mobility

Exercises could include:

• Lying supine over a rolled towel (either horizontal or vertical to the spine, depending on the clinical signs and symptoms)
• Exercise for Pectoralis major muscle with arms stretched, either side of a doorway
• Thoracic rotation –arms at 90 deg to the floor,
  in standing, holding a walking stick with both hands
• Side flexion – standing, Lying in prone, propped on elbows, arm reaching down the leg

Care-24 has a reputation based on listening, the client-centred approach and the commitment of all the team’s members.

Making the patient aware and making sure that all the steps of the treatment plan are clearly understood is essential.

This way, a relationship of trust is formed between the staff and the patient.

We often attract new clients through word-of-mouth, and these referrals are a source of great pride.

Our doctors always make a point of being a leader in terms of the use of technology. The patient is assured that he or she will receive outstanding care throughout his or her treatment.