Have you ever caught infection of pneumonia during your childhood days? If yes, the infection then might have been brought under control with effective medication but in the end you started having bouts of recurrent coughs. The fever would have subsided after treatment but complaint of cough and passing of phlegm would still persist. This might have happened because your lung caught TB infection, which was controlled after a few months of anti-tubercular treatment, but the cough still persisted even after the TB infection had been cured. Or have you been suffering from recurrent coughs and passage of phlegm since the age of 14? Sometimes you might have spitted out blood along with sputum and, on some occasions, the amount of blood spitted out was significant. Now there is no fever, but the problem of coughing and phlegm, which increases in amount especially during winters, continues. All these complaints lead to one suspicion: you are probably suffering from bronchiectasis of the lung. Take this disease seriously right now, otherwise you might face unpleasant and tormenting complications in future.

What is this disease all about?
Bronchiectasis is the name of chronic infection and inflammation of branches of wind pipe existing inside the lung. In this condition of bronchiectasis, the wall of wind pipes due to infection and inflammation becomes unusually weak. On account of these changes, branches of wind pipes no longer are able to maintain their tubular shape and in the process assume abnormal shapes like that of a balloon or cylinder. This weakened wall of windpipe is unable to throw out the sputum collected inside the branches of wind pipe. This results into accumulation of a large amount of phlegm inside the wind pipe. This stagnation of sputum blocks the tubes as well as branches of wind pipe connected to lung tissue. Because of obstruction, the part of the lung supplied (attached to) by these tubes, gets damaged and constricted. This leads to a state of inflated lung. The lymph nodes and blood pipes adjacent to the destroyed lung also become enlarged. The net result of these changes is that the damaged lung as well as wind pipe are unable to function properly and the affected patient develops a lot of complications.

Why does bronchiectasis occur?
The main reason of developing bronchiectasis is recurrent infection in wind pipe and its branches. The main cause of recurrent infection of lung is the infection of pneumonia. If pneumonia is not controlled effectively in its early stages, the problem of bronchiectasis of lung may emerge in due course of time.
The second important reason of development of bronchiectasis is tubercular infection. After proper medication, although tubercular infection leaves the lung, it makes a lasting impression on lung and wind pipe. As a result, the anatomy of these structures undergoes a change. This alteration in anatomical structure helps other types of germs to settle there permanently. These germs start disturbing the normal function of wind pipe. This is where the disease of bronchiectasis starts. In some persons, the bronchiectasis of lung is present since birth. In children, the common cause of bronchiectasis is generally due to cystic fibrosis, a congenital disease.
Sometimes, deficiency in blood of a special enzyme called Alpha-1 antitrypsin. Presence of rheumatoid arthritis and other autoimmune diseases also become important causes of development of bronchiectasis. Generally, children are in a habit of putting small things like peanuts, coins, fish bones in their mouth. These small things when swallowed by children sometimes actually enter the wind pipe instead of entering the food pipe and thereafter block it. At this point, part of the lung supplied by the blocked pipe starts developing bronchiectasis.

How to identify bronchiectasis?
Recurrent chest infections
Breathing difficulty
Recurrent episodes of unrelenting cough
Passing of a very thick and pus-like phlegm during coughing
Sometimes a cough bout lasts longer and there appears a gurgling sound during breathing

What to do if you are suffering from bronchiectasis?
Consult immediately a thoracic surgeon and always go to a hospital where facility of modern investigations like broncoscopy, thoracoscopy, spiral CT, angiography and bronchial artery embolisation are available. The role of chest x-ray and spiral CT is very significant in evaluation of bronchiectasis. On the basis of these results, we can say with surety which part of lung and wind pipe is diseased and destroyed. This information helps in formulating the correct treatment strategy for bronchiectasis.

What is the treatment of bronchiectasis?
A patient suffering from bronchiectasis should either on his own consult an experienced thoracic surgeon or request his treating physician to arrange consultation with a thoracic or chest surgeon. It has been observed in India that the surgeon who is more involved with heart surgery does not have much experience with lung surgery. Therefore, one should go to a hospital where lung surgery is routinely done and 24-hours availability of a full-time thoracic surgeon is there.
For effective treatment of bronchiectasis it is essential to find the cause of it. For the purpose of effective treatment the correct use of antibiotic is essential. All efforts should be put towards removal of sputum from damaged wind pipe. Some special medicines like bronchodilators and mucolytic agents have proved effective to some extent. Some special physical postures and physiotherapy are helpful in effective removal of phlegm.

Role of surgery in the treatment of bronchiectasis
Surgery plays an important role in the treatment of bronchiectasis. If any part of lung has been already destroyed due to bronchiectasis, it is a wise step to get that damaged part removed by a thoracic surgeon, otherwise the healthy part adjacent to the damaged one will also get diseased. In our country, majority of physicians underestimate the effective role of surgery in the treatment of bronchiectasis and therefore patients of bronchiectasis are deprived of timely and correct surgery. It is harmful to leave the damaged part of lung as such inside the chest.
Sometimes, patients of bronchiectasis pass out a large amount of blood during coughing. This puts their lives at risk. Therefore, patients of bronchiectasis should not sit idle if the amount of blood coughed out has increased significantly, and such patients should immediately go to a large hospital and consult a thoracic surgeon, who can find ways to control bleeding either through embolisation or surgery to save the patient’s life. The patients of bronchiectasis should start correct treatment during initial days, otherwise if both the lungs are engulfed by bronchiectasis completely, there will not be left any alternative other than lung transplant.

The writer is Senior Consultant at Department of Cardiothoracic & Vascular Surgery, Indraprastha Apollo Hospital, New Delhi. [email protected]

Dr KK Pandey