What Is Bronchiectasis?

Bronchiectasis is a condition when the bronchial tubes in the lungs are permanently damaged, thickened, or dilated, and can occur in more than one branch of the bronchus. The damage causes bacteria and mucus fluid to collect more easily in the bronchus that can trigger airway blockages and recurrent infections. Patients with bronchiectasis will be more susceptible to bacterial infections that can aggravate bronchial damage.

In general, patients with bronchiectasis can not be cured. But with good care, the supply of oxygen to the body through the lungs can be maintained and further damage to the lungs can be prevented, so that the quality of life of patients can increase.


Symptoms of Bronchiectasis
The main symptoms that can be observed from patients with bronchiectasis is a cough with phlegm that does not subside despite being treated. Sputum produced from cough due to bronchiectasis can be colored clear, pale yellow, or greenish yellow. Other symptoms are:

• Wheezing.
• Hard to breathe.
• Joint pain.
• Change the shape of the fingertips called clubbing finger, where the nails thicken and the shape of the fingertips into a round.
• Coughing blood or phlegm from cough mixed with blood.
• Have recurrent respiratory infections .
• Losing weight.
• Tired.

If bronchiectasis sufferers secondary to bronchial damage, symptoms of infection include:

• Unwell.
• Stabbing pain in the chest is increasingly felt when breathing.
• A cough that worsens with thickened sputum, turns more greenish, and gives off an unpleasant odor.
• Feeling very tired.
• The worsening of breath.
• Coughing blood.

If the following symptoms have arisen, the lung infection triggered by bronchiectasis has worsened and needs to be hospitalized. The symptoms of lung infections that need attention are:

• Cyanosis, the skin and lips and lips look bluish.
• Bewilderment and mental disorders.
• Breathing faster, more than 25 times per minute.
• Severe chest pain that causes difficulty breathing and difficulty coughing to release phlegm.
• Fever with temperature above 38.

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Causes of Bronchiectasis
Bronchiectasis results from damage to the bronchial tissue that is worsened by infection. Bronchial infections in patients with bronchiectasis increase the risk of infection in the lungs, which will make the bronchus increasingly inflamed and widened. Both of these things occur in a rotating and repetitive, so that damage to the bronchus and lungs getting worse.
Bronchial damage is triggered by an immune system response that seeks to eliminate the causes of infection, such as bacteria and viruses. The work of the immune system triggers an inflammatory reaction. In general, the inflammatory reaction will stop by itself without causing tissue damage. However, in bronchiectasis, inflammatory reactions cause permanent damage to elastic tissue and bronchial muscle tissue. Damage to both tissues leads to a dilation of the bronchial that actually increases the risk of infection.

Various conditions and diseases that can trigger permanent damage to the lung bronchus include:

• Connective tissue disease . Some diseases can cause inflammation of the connective tissue throughout the body, including in the bronchus, among others:
• Rheumatoid arthritis.
• Sjogren's Syndrome .
• Ulcerative colitis.
• Crohn's disease .
• Allergic bronchopulmonary aspergillosis (ABPA). Patients with this disease have an allergy to Aspergillus fungus that actively remove spores. If an ABPA sufferer breathes Aspergillus spores, spores can trigger an allergic and inflammatory reaction, which then causes bronchiectasis.
• Cystis fibrosis . It is a genetic disease that causes the lungs to be disturbed by a clump of mucus. The mucous fluid present in the lungs can be an ideal place for bacteria to multiply and cause infection and trigger bronchiectasis
• Chronic obstructive pulmonary disease (COPD). COPD is a class of progressive lung disease that causes difficulty breathing sufferers due to damage to the alveoli and bronchi. Examples of diseases classified as COPD are chronic emphysema and bronchitis. Like bronchiectasis, COPD disease also can not be cured, but the symptoms and development of the disease can be controlled so that the quality of life of the patient can be maintained.
• Lung infection as a child. About one-third of cases of bronchiectasis can be associated with small childhood lung infections, such as whooping cough, tuberculosis, and severe penumonia.
• Immunodeficiency. In people with low immune system (immunodeficiency), the lungs are more susceptible to infection so that the risk of exposure to bronchiectasis is higher. Immunodeficiency can occur due to a genetic or nongenetic disease, such as HIV infection.
• Aspiration. This condition occurs when the contents of the stomach inadvertently enter the lungs. Because the lungs are very sensitive to the presence of foreign objects, no matter how small the incoming objects can trigger an inflammatory reaction that can damage the tissue.
• Ciliary disorders. Silia are the fine hairs that surround the surface of the respiratory tract. The function of cilia is to help remove excess mucus from the surface of the respiratory tract. If ciliary function is impaired, there will be a buildup of mucous fluid that can cause blockages in the respiratory tract and facilitate the occurrence of infection. The condition of cilia disorder can be caused by various diseases, among them are primary ciliary dyskinesia and Young disease .

Diagnosis of Bronchiectasis
The doctor may suspect a patient with bronchiectasis if he or she experiences symptoms as described above. Suspicions can be strengthened if the patient has an unhealthy lifestyle, such as smoking. To confirm the diagnosis, the doctor will recommend a number of further tests, and one of them is sputum analysis.

In sputum analysis, the doctor will take samples of sputum patients to be examined in the laboratory. Bronkiektasi sufferers will have a kind of whitish or yellowish concentration on the sputum called diktrich lump. Meanwhile, to check the presence of bacteria in sputum, doctors can perform techniques of Gram staining and bacterial culture. In addition, the presence of Aspergillus spores and fungus can also be known in this examination.

Another type of advanced test that can help diagnose bronchiectasis is a high resolution computerized tomography scan (HRCT scan). This is actually the most accurate method of detecting the occurrence of bronchiectasis. In the HRCT scan, lung images will be taken from different angles using X-rays, and then combined using a computer. With the combined image, the lung conditions can be mapped more accurately. In healthy lungs, the bronchi branches in the lungs will further narrow as the number of bronchi branches increases (similar to branching in the tree). However, if the HRCT scan shows the same or even increased bronchi width, then it can be presumed that the patient has bronchiectasis.

In addition to sputum analysis and HRCT scans, there are other methods that can help diagnose bronchiectasis, including:

• Blood tests. Blood tests are performed to check blood conditions and the ability of the immune system to work against pathogens such as viruses, bacteria, and fungi. Type of blood tests that can be done is a complete blood test. Patients suffering from bronchiectasis, often the number of blood cells become abnormal, among them is an increase in the number of white blood cells, especially neutrophils and eosinophils, or decreased red blood cell count and hemoglobin ( anemia ).
• Sweat test. Sweat bronchiectasis patients will be collected and analyzed the salt content. In patients with bronchiectasis caused by cystis fibrosis, high salt content will be found.
• Lung function test. This is a method used to analyze the performance and function of the lungs in breathing. In this test, the doctor will ask the patient to exhale as strong and as fast as possible into a measuring device called a spirometer.
• Bronchoscopy. Bronchoscopy is a visual hose-shaped visual aid with a camera, which is inserted into the lungs to show the inside of the organ. Bronchoscopy can be used to see the presence of foreign objects in the lungs that can trigger an inflammatory response and cause bronchiectasis.
• Aspergillus precipitins and IgE serum. To diagnose whether a person has an Aspergillus infection (APBA) that triggers bronchiectasis, both tests can be performed.
• Autoimmune screening test. To determine whether bronchiectasis occurs due to autoimmune disease, an autoimmune screening test may be performed.

Treatment of Bronchiectasis
Treatment of bronchiectasis involves various types of treatment performed on an ongoing basis. Because lung damage caused by bronchiectasis is permanent, the goal of treatment is not to cure the disease, but to relieve symptoms, reduce and prevent complications, prevent disease from getting worse, and reduce morbidity and mortality.
It is important to recognize and diagnose bronchiectasis at an early stage. In addition, treating the disease that causes bronchiectasis is also a treatment goal. Some things related to handling bronkiektasis include:

• Relieve symptoms of bronchiectasis. Keep in mind that bronchiectasis can not be cured, but the symptoms can be controlled so as not to deteriorate. Some steps to relieve symptoms of bronchiectasis are:
• Quit smoking.
• Avoid becoming a passive smoker.
• Get the smallpox vaccine, rubella , and whooping cough.
• Oxygen therapy for bronchiectasis patients with hypoxemia and severe complications.
• Special treatment (including in terms of nutrition and psychology) for patients with bronchiectasis due to cystis fibrosis.
• Get flu vaccine every year.
• Obtain pneumococcal vaccine to avoid pneumonia .
• Doing physical exercise regularly.
• Maintain body fluids.
• Maintaining a balanced diet nutrition.
• Giving antibiotics. The purpose of antibiotics is to treat bacterial infections in patients with bronchiectasis that can aggravate the condition. To determine the exact antibiotic, the doctor will perform sputum analysis. While awaiting results, doctors will give broad-spectrum antibiotics. Some types of antibiotics that can be given for patients with bronchiektasis include: clarithromycin , azithromycin, sulfamethoxazole, doxycycline, levofloxacin , or tobramycin.
• Antiinflammatory Drugs. The purpose of anti-inflammatory drug administration is to modify the immune system response at the time of infection so as to reduce tissue damage. Some anti-inflammatory drugs, such as beclomethasone, may be administered via a nebulizer device. Examples of classes of anti-inflammatory drugs that can be given to people with bronchiectasis are:
• Corticosteroids.
• Leukotriene inhibitors.
• Non-steroidal antiinflammatory drugs (NSAIDs) .
• Bronchodilators. Bronchodilators are given to relieve symptoms of bronchiectasis which causes breathing difficulties. The bronchodilator relaxes the lung muscles so that the patient can breathe easier. Some examples of bronchodilator drugs are:
• The beta2-adrenergic agonist .
• Anticholinergics.
• Theophylline .
• Exercise active cycle of breathing technique ( ACBT). This exercise serves to bronchiectasis patients can remove mucus fluid from the respiratory tract by regulating the rhythm of the breath. Starting from normal breathing, take a deep breath, then remove the mucus through the respiratory tract. ACBT exercise should be assisted by physiotherapy to avoid lung damage.
• Surgery. New surgery may be recommended to bronchiectasis patients if only one lobe of the lung has bronchiectasis, the patient has no underlying condition of bronchiectasis to relapse, or bronchiectasis symptoms do not subside after various treatments are administered. Surgery is performed by removing lung lobes affected by bronchiectasis.

Complications of Bronchiectasis
The most dangerous complication of bronchiectasis is a very powerful cough (hemoptysis). This condition occurs due to one part of the blood vessels that provide blood for the open lungs and bleeding. Symptoms of haemoptysis include:

• Cough bleed more than 100 ml for 24 hours.
• Difficult breathing caused by blood blocking airflow in the lungs.
• Head dizzy.
• Dizzy.
• Chills and skin feel wet and cold due to blood loss in large quantities.

Massive hemoptysis that occurs in patients with bronchiectasis is a medical emergency that must be addressed. To overcome hemoptysis, doctors will perform arterial bronchi (BAE) embolization by clogging bleeding sources in lung guided by X-ray scans.


Prevention of Bronchiectasis
Some cases of bronchiectasis occur due to respiratory tract infections. To prevent infection that can trigger bronchiectasis, the following steps can be taken:

• Avoid and stop smoking.
• Avoid polluted air, cooking smoke, and harmful chemical compounds.
• Receive influenza vaccinations, whooping cough, and smallpox, especially in childhood.
• Diagnosis of bronchiectasis from an early stage, so as to prevent the development of this condition becomes more severe.

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