Caring for your lungs and understanding the disease can be daunting at first, here is some information to help get you on your way.
What is Bronchiectasis?
Bronchiectasis is a chronic lung disease where the main airways of the lungs (the bronchi) become dilated or inflamed. This causes mucous to build-up in the lungs, which will in turn starts a vicious cycle of lung infections, more inflammation and more infections.
Bronchiectasis is not curable but it is manageable.
How is Bronchiectasis diagnosed?
Bronchiectasis diagnosis can be a long journey with several stages. If bronchiectasis is suspected, your doctor will order a chest CT scan, as this will confirm the diagnosis and also indicate which lobes in the lungs are affected. Once the diagnosis of bronchiectasis is made, some blood tests and sputum cultures will be done to rule out the cause of bronchiectasis. Pulmonary function tests will also be performed to determine how well your lungs are working.
What causes bronchiectasis?
Sometimes we cannot find the cause of bronchiectasis but we do find a link with some other diseases for example;
- Past infections such as pneumonia, tuberculosis, or measles
- Immune deficiencies
- Autoimmune disorders such as Rheumatoid Arthritis, Lupus, Sjogren’s
- Inflammatory bowel disease such as Celiac, Crohn’s or Ulcerous Colitis
- Some genetic conditions such as Cystic Fibrosis, Alpha 1 Antitrypsin Disorder, Primary Ciliary Dyskinesia
- Gastro-oesophagus reflux disease, (GERD) or sometimes called “reflux”, because of aspirating food contents in the lungs during or after meals can damage the lungs
What are the symptoms of Bronchiectasis?
The main symptom is a chronic productive cough where you cough up mucous every day. The mucous can range in color from clear to yellow to dark green depending on the day. Some people experience shortness of breath, wheezing, and fatigue that can limit their physical activities. Chest tightness and muscle pain around the chest can also occur with too much coughing.
In some cases, people with bronchiectasis can cough up some blood and experience weight loss.
What is the Treatment for Bronchiectasis?
Clearing the lungs of germs is called airway clearance techniques (ACT), and this will need to be a daily priority to remove bacteria that settles in the mucous. The mucous is usually thick and sticky and will need your help to bring it up so you can cough it out. Getting the mucous out of your lungs should decrease coughing during the day and in turn can reduce shortness of breath and fatigue.
There are many airway clearance techniques such as:
- Specific breathing exercises called “active cycle of breathing technique (ACBT)”, and “autogenic drainage (AD)”.
- Postural drainage, which means lying in a specific position to let the mucous drain by gravity, can be done with another technique at the same time. Postural drainage is not recommended, for certain people, in particular people who have reflux should not practice lying down flat, to prevent aspirating food content in their lungs.
- There are also specific devices called Oscillating Positive Expiratory Pressure devices (OPEP devices), that can help get the mucous out of your lungs. When you breathe through an OPEP device, it will help keep your airways open and the vibrations from the device will loosen up the mucous and move it up the airways so it can be coughed out.
- Breathing a specific salt solution called hypertonic saline or normal saline with a nebulizer can also assist with thinning out the thick mucus.
Choosing the airway clearance technique that works best for you, will improve your self-confidence and give you the motivation you need to continue your daily treatments. Treating lung infections early with antibiotics will also prevent further lung damage.
Lifestyle changes will need to be reviewed to improve your quality of life while living with bronchiectasis, for instance, daily exercise which helps loosen up the mucous from your lungs. Eating a healthy diet and eating small frequent meals may prevent weight loss. Keeping well hydrated and limiting caffeine and alcohol will prevent dehydration as the mucous needs to be well hydrated to be thin enough to move up the airways so that it can be coughed out.
Taking an active role in your lung health will give you some control in managing bronchiectasis as you can chose the time of day that suits you best to practice your preferred airway clearance technique.
What You Need to Remember:
- The main symptom is a chronic productive cough
- A chest CT scan is needed for diagnosis
- Treat the underling condition if it is identified
- Daily airway clearance techniques are the main treatment
- Self-management education is recommended to help improve quality of life
- Bronchiectasis is manageable, talk to your primary health care provider if you have questions
References:
- 1. British Thoracic Society (2018). Guideline for Bronchiectasis in Adults: A summary for the general public. https://www.brit-thoracic.org.uk/quality-improvement/guidelines/bronchiectasis-in-adults/
- 2. Hill, Adam T., et al. (2019). British Thoracic Society Guideline for bronchiectasis in adults. Thorax. 74.Suppl 1, 1-69.
- 3. Chalmers, J. D., et al. (2019). Bronchiectasis. European Respiratory Society.
About the author
Isabelle LeClerc, RN leads a chronic disease self-management program in an Academic Primary Care Centre in Ottawa. Her main areas of interest are Bronchiectasis and Chronic Non-Cancer Pain self-management education. She has presented posters of her work in Canada, and internationally, and continues to give workshops to health care professionals, in the goal of developing chronic disease self-management programs in their practice. Her passion for helping patients manage their health has taken her around the world, to the World Bronchiectasis Conferences in Germany, Italy and the USA. She was a presenter at the 3rd World Bronchiectasis Conference; patient session, in Washington DC in 2018. Isabelle is a member of the Ottawa Pain Medicine Program Strategic Advisory Committee and has participated in the review of Living Well with COPD 3rd edition.
