1) Department of Internal Medicine, Athena Villa dei Pini Clinic, Piedimonte Matese (CE);
2) Division of Internal Medicine, A.G.P. Piedimonte Matese (CE);
Definition
Bronchiectasis are chronic dilations of the bronchi, with a caliber greater than 2 mm, due to the destruction of their walls; bronchiectasis can be congenital (ie present from birth) or acquired (ie caused by a disease, such as bronchitis, inflammation or other factors, such as old age or smoking). The very rare congenital forms are due to malformations or weakness of the walls of the bronchi. The acquired forms, on the other hand, derive from the destruction of the elastic component of the bronchi, caused by an "infection.
Symptoms
For further information: Bronchiectasis Symptoms
When the patient presents symptoms similar to that of bronchitis, but not easily influenced by therapy, it is reasonable to think of a bronchiectasis. The main symptom is cough, especially in the morning, characterized by sputum rich in pus (more or less liquid material formed by microbes and dead cells) and sometimes with blood. Respiratory infections are frequent, especially pneumonia, accompanied by fever, weight loss, fatigue and shortness of breath. As the bronchiectasis process evolves, pulmonary tissue destruction occurs, with areas of scarring and emphysema, resulting in a state of pulmonary insufficiency.
Diagnosis
The diagnosis must be suspected based on the symptoms described. Chest radiography may be normal, while bronchial changes are clearly highlighted with high resolution chest CT scan. Bronchoscopy can be useful in unilateral forms, to exclude the presence of tumors or foreign bodies, and in bilateral forms, to remove secretions and analyze their characteristics (microbiological and cytological tests).
Therapy
Medical therapy aims to prevent infections and, in the event of exacerbations, to treat germs isolated by microbiological examination of the sputum with broad-spectrum antibiotics. It is also necessary to avoid cigarette smoke and the inhalation of irritants. Respiratory gymnastics and bronchial unblocking techniques can be useful, which, if performed regularly, can facilitate the elimination of secretions. In the most advanced forms, if significant hypoxemia occurs, it is necessary to begin treatment with oxygen therapy to maintain adequate levels of oxygenation in the blood. In selected cases, especially in the unilateral and circumscribed forms, surgical resection of bronchiectasis can be used. This surgical device is also usually used as a matter of urgency in case of massive pulmonary haemorrhage, in which it is the bleeding vessel removed or embolized. The prognosis depends on the extent of the disease and the patient's response to medical therapy. It is usually poor in the forms with diffuse bronchiectasis and which cause significant hemoptysis.
Lung transplantation may be considered in later stages.
By Correspondence: Dr. Luigi Ferritto
Department of Internal Medicine Clinical Respiratory Physiopathology Unit "Athena" Villa dei Pini
Piedimonte Matese (CE)
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