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Discussion:
Bronchiectasis
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Does anyone else know if they have this ?
Posted on 10/29/08, 05:40 pm
25 Replies | Most Recent Add Your Reply
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Email me when others reply to this topic help
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Reply #1 - 10/30/08  2:16pm
" I think most asthmatics have this whether they know it or not.

From Wikipedia:

http://en.wikipedia.org/wiki/Bronch...

Bronchiectasis is a disease that causes localized, irreversible dilatation of part of the bronchial tree. Involved bronchi are dilated, inflamed, and easily collapsible, resulting in airflow obstruction and impaired clearance of secretions. Bronchiectasis is associated with a wide range of disorders, but it usually results from necrotizing bacterial infections, such as infections caused by the Staphylococcus or Klebsiella species or Bordetella pertussis.

What this means is the bronchial tubes are distended and distorted allowing bacteria and other crap to accumulate and causing various infections. Treatment consits of treating these infections. There is no way to reverse the damage.

As a side note, this is exactly why I am against bronchial thermoplasty ablataion in which brochial tubes are bascially microwaved into an open position with a heated surgical instrument. Yes, the tubes will be permanently open possibily temporarily releiving asthma, but physically causing surgical bronchiectasis - so what's the point?! Dumb and dangerous move.

How was this confirmed? Xray and/or CT scan? Get a CT scan if one wasn't done already and have it repeatedly annually or biannually to keep an eye on this. "
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Reply #2 - 10/31/08  8:10am
" high-res. CT scan, and im scared to death. so, u think i shouldn't be too scared? "
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Reply #3 - 11/01/08  1:12am
" Having dealt with this issue before myself, I would personally say: Don't be scared, be smart. This is simply a fancy word for what is common lung damage in most asthmatics.

What it does mean is you need to take common sense precautions against respiratory disease such as: get both a flu and pneumonia shot, stay out of crowded public areas during the holiday season and limit your exposure to small children, clean your hands with antibacterial solutions often, wear a mask if prolonged crowd exposure is unavoidable, and also ask for a prescription for a supplement.

Should you become sick, even with a common cold, immediately call the doctor - Do not wait. Discuss profilactic antibiotic use during the winter season, though most doctors today are against this due to resistence.

Always keep a supply of emergency meds on hand including: albuterol, nebulizer fluid, pred, antibiotics, etc. If you can't get a doctor right away, use the supplies and ask questions later.

Most importantly, you need to call your doctor and dicuss this diagnosis and what you need to do from here. Ask about pulmonary rehab which can help strengthen your lungs. This will not go away or improve. It's best to be proactive and involved in your own care. "
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Reply #4 - 11/02/08  9:07am
" I agree with AiryL 100%, it is part of our disease ! If I even feel like I might get a bug, I use Airborne tablets for a few days to help my immune system along with the probiotic I use every day. Flu & pneumonia shots are vital for us. Keep your confidence and follow the common sense rules. We're here to help you through. Hugs, Marie "
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Reply #5 - 11/04/08  3:11am
" Hi, just thought I would add my two cents. I have Bronchiectasis. I also have COPD, Asthma, Cor Pulmonale also known as Right Sided Congestive Heart Failure and Sleep Apnea, and Pulmonary Hypertension. I would disagree. Bronchiectasis is not common, in fact it is relatively uncommon. It does develop as a result of repiratory disease. My pulmonary doc said, as a simple explanation, that little pockets have formed in the airway. It the pockets infected secretions. Bronchiectasis is a chronic illness of which there is no cure. I have to take a series on antibiotics beginning the first of every month. I take four different antibiotics and alternate them through the four months. I run a constand low grade temp due to the Bronchiectasis and have general flu like symptoms daily. (muscle aches and pains) The antibiotics will not cure me. The goal of the antibiotic treatment is to prevent progression of the disease. (to stop it from getting worse. So, just for your information, just because you have ashtma it is not an automatic that you will also have Bronchiectasis. (However, you are at risk)It is pretty miserable, so I really hope you guys do not get it. I am going to paste in some info I found at a really good online source. I will also paste in the web address in case you want to read the whole article in its entirity. (It is really long)

http://www.emedicine.com/med/topic2...

Background
Bronchiectasis is an uncommon disease that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways, most often secondary to an infectious process. First described by Laennec in 1819, later detailed by Sir William Osler in the late 1800s, and further defined by Reid in the 1950s, bronchiectasis has undergone significant changes in regard to its prevalence, etiology, presentation, and treatment.

Bronchiectasis can be categorized as a chronic obstructive pulmonary lung disease manifested by airways that are inflamed and easily collapsible, resulting in air flow obstruction with shortness of breath, impaired clearance of secretions often with disabling cough, and occasionally hemoptysis.

Bronchiectasis most often presents as (1) a focal process involving a lobe, segment, or subsegment of the lung, or (2) a diffusing process involving both lungs. The former is by far the most common presentation of bronchiectasis, while the latter is most often associated with systemic illnesses and/or sinopulmonary disease and asthma.

Diagnosis is usually based on a compatible clinical history of chronic respiratory symptoms, such as a daily cough and viscid sputum production, as well as radiographically by characteristic findings, such as bronchial wall thickening and luminal dilatation, on CT scan.

Pathophysiology
Bronchiectasis is an abnormal dilation of the proximal and medium-sized bronchi (>2 mm in diameter) caused by destruction of the muscular and elastic components of the bronchial walls. Affected areas may show a variety of changes including transmural inflammation, edema, scarring, ulceration, and other findings. Distal lung parenchyma may also be damaged secondary to persistent microbial infection and frequent postobstructive pneumonia. It can be congenital or acquired but is most often the latter.

Congenital bronchiectasis usually affects infants and children and results from developmental arrest of the bronchial tree. The more commonly acquired forms occur in adults and older children and require an infectious insult, impairment of drainage, airway obstruction, and/or a defect in host defense. The tissue is also damaged in part by the host response of neutrophilic proteases, inflammatory cytokines, nitric oxide, and oxygen radicals. This results in damage to the muscular and elastic components of the bronchial wall. Additionally, peribronchial alveolar tissue may be damaged, resulting in diffuse peribronchial fibrosis.

The result is abnormal bronchial dilatation with bronchial wall destruction and transmural inflammation. The most important functional finding of altered airway anatomy is severely impaired clearance of secretions from the bronchial tree.

Impaired clearance of secretions causes colonization and infection with pathogenic organisms, contributing to the common purulent expectoration observed in patients with bronchiectasis. The result is further bronchial damage and a vicious cycle of bronchial damage, bronchial dilation, impaired clearance of secretions, recurrent infection, and more bronchial damage.

In 1950, Reid characterized bronchiectasis as cylindrical, cystic, or varicose in nature.


Cylindrical bronchiectasis involves diffuse mucosal edema, with resultant bronchi that are dilated minimally but have straight, regular outlines that end squarely and abruptly (see Image 1).
Cystic or saccular bronchiectasis has ulceration with bronchial neovascularization and a resultant ballooned appearance that may have air-fluid levels (see Image 2).
Varicose bronchiectasis has a bulbous appearance with a dilated bronchus and interspersed sites of relative constriction and, potentially, obstructive scarring. The latter may subsequently result in postobstructive pneumonitis and additional parenchymal damage (see Image 3).
http://www.emedicine.com/med/topic2... "
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Reply #6 - 11/04/08  3:24am
" PS I agree with everything you all said, except that it is not automatic that you have it and do not know you have it. I do not mean to be disrespectful or disafreeable to anyone. YOu all had good posts and I appreciate what you said! JoAnn "
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Reply #7 - 11/04/08  8:29am
" From National Jewish Health site:

www.nationaljewish.org/disease-info...

How do you get bronchiectasis?

You may be born with bronchiectasis. You may also acquire it as an adult or child through one or more of the following ways:

Inhalation of oral or stomach material into your lungs. Impaired ability to swallow may also cause saliva or food to enter the lungs. Severe heartburn (gastroesophageal reflux disease) occurs when the valve or sphincter connecting your esophagus and stomach is too relaxed. This may allow a backward flow of stomach contents to enter your lungs and irritate the airways
Having another chronic lung condition, such as cystic fibrosis, allergic aspergillosis, tuberculosis, other mycobacterial diseases such as MAI, whooping cough (pertussis), an immune deficiency disease or severe or repeated episodes pneumonia
Disorders that affect the function of the cilia (small hairs that line the airways)
Obstruction in your airways because of a growth or tumor
Kartagener's Syndrome. This is a rare inherited disease. It combines bronchiectasis, loss of ability to clear mucus and chronic sinusitis.

In the first and second points listed, this can develop as a result of severe GERD or repeated lung infections as with asthma. Though emedicine may list this as "uncommon", it is actually not unusual and if anything is underdiagnosed.

If concerned about this, ask for a high resolution CT scan. "
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Reply #8 - 11/04/08  7:40pm
" Hi you guys! Well...now my mind is really wondering.... (you know..."wondering minds want to know"???teehee! Where is that saying from??? Anyone know?) Seriously, I was under the impression from my pulmonary doc that this is an unusual disease. That there is no cure for it. That I developed it as a result, not of my Asthma, but rather of my COPD. He explained it to me as little mucus filled pockets in my airways. that infection has set in the disease and cannot be cured. That I have to take the antibiotics, (4 different that I alternate monthly) monthly to try to slow the progression, because it is a chronic, progressive disease. So, my mind is boggled by the contradiction both in opinion and in documetations and internet links. It seems you can find an internet site that supports both views. Because I am diagnosed with this disease and am being treated for it, I do have vested interest. So, in light of that, I have sent a hug to Dr. OOrange requesting she come in and read our posts and comment. Not to settle anything except my own curiosity. Hopefully, she will do that. Maybe it is a question of degree? Maybe there are levels of having it. You know like mild, medium, ect.. I know COPD definitely has different classifications. Maybe the same is true with Bronchiectasis? Who knows? But, I'd like to know! Hugs to you all! JoAnn "
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Reply #9 - 11/04/08  11:40pm
" Let me help sort this out...

How common is it?
1) 110,000 individuals have bronchiectasis in the United States and the prevalence of bronchiectasis increases with age.
2) Bronchiectasis is more common in women

How do we make the diagnosis?
1) The diagnosis is usually established clinically on the basis of chronic daily cough with sputum production. This is a cough with the production of mucopurulent and tenacious sputum lasting months to years.
2) On CT scan the presence of bronchial wall thickening and luminal dilatation.

How does it happen? To try and keep it simple Bronchiectasis requires two factors:
1) An infectious insult
2) Impaired drainage, airway obstruction, or a defect in host defense

What causes it?
1) There are numerous causes that can induce or contribute to the processes that result in bronchiectasis.
2) They include airway obstruction (eg, foreign body aspiration), defective host defenses, cystic fibrosis, rheumatic and systemic diseases, dyskinetic cilia, pulmonary infections, allergic bronchopulmonary aspergillosis (ABPA), and cigarette smoking.

If you have some of the symptoms listed above what should be done to make sure you dont have this?
1) Xray can detect bronchiectasis in some but not all so CT of the Chest is the recommended test
2) The goal is identification of potentially treatable causes
3) Tests we do are laboratory testing, radiographic imaging, and pulmonary function testing

No, most asthmatics dont have bronchiectasis but it can happen....
Dr O. "
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Reply #10 - 11/04/08  11:55pm
" Thank you so much Dr OOrange for your response in answering our questions on this issue. Wow, only 110,000 out of the population of the United States. I have so many different diagnosis that I really like to understand what I have been diagnosed with. Thank you so much for clarifying this for me/us. I am sure we all appreciate the time you took to answer our questions.

Hey all...we have a new president!!! Here is to a new and beautiful future for us all! "

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