Bronchiectasis or bronchial dilatations: when they occur and how to treat them

Dr. Eva Polverino, pulmonologist at the Hostafrancs Medical Center and at the Hospital Clínic of Barcelona, as well as CEO, founder and coordinator at the Italo-Catalan Medical Center ItaCa, explains what bronchiectasis is and how to treat it. These are dilatations of the bronchi that cause coughing and difficulty in breathing, among many other symptoms.

A bronchiectasis is a chronic respiratory pathology that is defined by the presence of permanent bronchial dilatations and is usually manifested by chronic cough and expectoration and frequent infections (bronchitis, pneumonia) that are an expression of chronic inflammation of the airway and bronchial infection.

Why do bronchiectasis occur?

Bronchiectasis can be caused by a large number of different reasons. These include:

– “poorly cured” or severe respiratory infections from the past.
– alterations of the immune system (antibody deficiency, etc.)
– cystic fibrosis (a rare genetic disease)
– alterations of the cilia lining the airways
– COPD (Chronic Obstructive Pulmonary Disease)
– asthma
– rheumatologic diseases
– inflammatory bowel diseases
– many other less common pathologies

It is important to try to investigate the initial cause of bronchiectasis because some have a specific treatment or management that can considerably improve the prognosis of the disease.

Symptoms that alert the patient to suffer from bronchiectasis

Cough and chronic expectoration, as well as frequent infections (bronchitis or pneumonia) are the most common symptoms of bronchiectasis, but shortness of breath (dyspnea), hemoptysis (blood in the sputum), chest pain, fatigue, wheezing, etc. are also described.

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Diagnosis of bronchiectasis

Although the clinical history and the chest X-ray can be very helpful to the Pneumology specialist in suspecting the disease, only high-resolution CT can confirm the diagnosis, i.e. the presence of bronchiectasis. Apart from this test, a series of other tests can be performed (depending on each case) to look for the specific cause of bronchiectasis.

Recommended treatment for bronchiectasis

As it is a very heterogeneous disease in terms of causes and clinical presentation, the treatment is variable depending on each case. In general, the use of bronchodilators is indicated when there is bronchial hyper-reactivity, while respiratory physiotherapy is indicated in all cases of abundant secretions or difficulty in expectoration. Finally, in case of fatigue and dyspnea, rehabilitation is recommended. The use of antibiotics is quite frequent because the exacerbations of this disease are almost always of infectious cause and because up to more than half of the patients may have some type of chronic infection. In case of chronic bronchial infection and frequent exacerbations, antibiotics can be used prophylactically, either orally (a few days a week) or inhaled, in selected cases. In any case, treatment should be assessed and decided on a case-by-case basis.