Bronchiectasis is not scary, recognizing it is the first step!

Author: Yu Hanyu, Xiangya Hospital, Central South University

Li Yuanyuan, Associate Chief Physician, Xiangya Hospital, Central South University

Reviewer: Hu Chengping, Xiangya Hospital, Central South University, Chief Physician

In recent years, the incidence and prevalence of bronchiectasis reported internationally have increased year by year. In order to draw people's attention to bronchiectasis, July 1, 2022 was designated as the first World Bronchiectasis Day.

1. What is bronchiectasis?

Bronchiectasis is caused by recurrent purulent infections due to various diseases, which lead to repeated damage and/or obstruction of small and medium airways, resulting in structural damage to the bronchial wall, causing bronchial abnormalities and persistent dilation [1]. Bronchiectasis is a common disease in the respiratory department, with clinical manifestations mainly including chronic cough, large amounts of sputum and/or intermittent hemoptysis, shortness of breath and respiratory failure. Patients are often hospitalized multiple times due to repeated infections and acute exacerbations of bronchiectasis.

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2. What are the causes of bronchiectasis?

Several known causes include previous lower respiratory tract infection, immune deficiency, genetic factors, airway obstruction, recurrent aspiration, and other lung diseases (such as previous measles, tuberculosis, etc.). In addition to these common causes, most patients with bronchiectasis still cannot identify the cause, which is called "idiopathic bronchiectasis" [1].

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3. How do I know if I have bronchiectasis?

High-risk groups for bronchiectasis: those with long-term cough, sputum or blood in sputum, or the only symptom is hemoptysis; those with frequent acute exacerbations of chronic obstructive pulmonary disease, severe asthma or poorly controlled symptoms and previous sputum culture results showing Pseudomonas aeruginosa infection; chronic sinusitis, rheumatoid arthritis or other connective tissue diseases; AIDS patients.

If the following symptoms occur, you need to be alert to bronchiectasis and it is recommended to go to the hospital for treatment in time.

•Chronic cough and sputum: long-term cough accompanied by a large amount of purulent sputum, which is yellow or green in color. The amount of sputum increases after catching a cold (acute exacerbation period).

•Recurrent hemoptysis: manifested as blood in sputum or even massive hemoptysis.

•Clubbing : The ends of the fingers or toes become thickened and hypertrophic, and the nails are arched from the base to the tip and look like a "drumstick".

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The "gold standard" for diagnosing bronchiectasis should be based on imaging manifestations and clinical symptoms. Comprehensive diagnosis and treatment should also combine methods such as sputum culture, etiology and bronchiectasis severity scoring.

4. What are the treatments for bronchiectasis?

Bronchiectasis is a chronic airway disease that, like asthma and chronic obstructive pulmonary disease, has stable periods and acute exacerbation periods. Acute exacerbation of bronchiectasis is defined as the occurrence of three or more of the following six symptoms, including frequent cough, increased sputum volume or change in properties, increased purulent sputum with or without wheezing, dyspnea, hemoptysis, and general discomfort, with symptoms lasting for 48 hours or more and the clinician deems it necessary to change the current treatment plan for the condition.

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Although bronchiectasis cannot be completely cured, standardized and timely treatment can still delay disease progression and reduce acute exacerbations, thereby maintaining or improving lung function, improving symptoms and improving quality of life.

The treatment of bronchiectasis in the stable stage mainly includes airway clearance, expectorant therapy, long-term antibacterial drug treatment, pathogen elimination, etc.; the acute exacerbation stage mainly includes anti-infection treatment. Other treatments include surgery, vaccination, and the use of bronchodilators. In addition, corresponding symptomatic supportive treatment should be taken for the complications of bronchiectasis (such as hemoptysis, chronic respiratory failure, etc.) [2].

For patients with stable bronchiectasis, airway clearance is a simple, convenient, non-invasive and preferred treatment method. The "Expert Consensus on Diagnosis and Treatment of Bronchiectasis in Adults in China" released in 2021 recommends long-term use of airway clearance treatment for patients with stable bronchiectasis. Traditional airway clearance methods include postural drainage and chest percussion, which are two commonly used and very simple clearance treatment methods.

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For those with a lot of sputum and difficulty expectorating, postural drainage and back patting are recommended. Young people can try yoga training, and the elderly can use fitness equipment outdoors for low-intensity exercise. For those with difficulty expectorating or poor postural drainage, expectorants can be used for a long time (≥3 months). If patients have chronic obstructive pulmonary disease and asthma at the same time, bronchodilators should be used before expectorant treatment, which will have a better expectorant effect.

Currently, a relatively new and easy-to-use clearance technique is the active cycle breathing technique, which is calm breathing - deep inhalation - holding breath for 3 seconds - forceful exhalation. This cycle of breathing training can effectively improve lung ventilation. In addition, patients can also try to forcefully exhale (i.e. appropriately extend the exhalation time), such as slowly "blowing" on the palm of their hands, which is helpful for expelling sputum from the periphery of the lungs.

In summary, patients with bronchiectasis need to find the most suitable method of expectoration for themselves, and communicate effectively with their doctors or rehabilitation therapists to achieve the best treatment effect.

5. How can patients with bronchiectasis manage themselves?

Patients with bronchiectasis should exercise good self-management, get the flu vaccine on time, learn about the disease, understand the characteristics of bronchiectasis, be able to identify acute exacerbations and seek medical attention as soon as possible. Patients should not blindly take antibacterial drugs on their own. Wear a mask at ordinary times, avoid colds, and try to avoid crowded places.

It is recommended that patients with mild bronchiectasis have an outpatient follow-up at least once a year to assess their disease status; for patients with moderate to severe bronchiectasis, it is recommended that they be assessed at least once every six months, and their lung function be assessed once a year. Patients are advised to seek medical attention promptly when they are in the acute exacerbation stage or feel unwell, and receive appropriate treatment after evaluation and examination by a doctor [2].

After reading the above content, you should understand that bronchiectasis is not terrible. Patients should achieve early detection, early diagnosis, early treatment, regular follow-up, timely medical treatment, not blindly and indiscriminately take antibiotics, and do a good job of self-monitoring of sputum changes.

References

[1] Bronchiectasis Expert Consensus Writing Collaboration Group, Chinese Medical Association Respiratory Diseases Branch Infection Group. Chinese expert consensus on the diagnosis and treatment of bronchiectasis in adults [J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2021, 44(4): 311-321.

[2]Xu Jinfu, Qu Jieming, Song Yuanlin. Bronchiectasis[M]. Beijing: People's Medical Publishing House, 2021.