Bronchiectasis a destructive lung disease characterized by chronic (permanent/irreversible) dilatation of the bronchi associated with persistent though variable inflammatory process in the lungs

Causes

Differential diagnosis

Prevention

Homoeopathic Treatment

The disease affects between 1 per 1000 and 1 per 2,50,000 adults. Moreover, the disease is more common in women and increases as people age. Additionally, Cystic fibrosis identify as a cause in up to half of cases.

Bronchiectais without CF is known as non-CFbronchiectasis. Lastly, Historically, about half of all case of non-CFbronchiectasis were found to be idiopathic, or without a known cause.

In detail, there are many causes that can induce or contribute to the development ofbronchiectasis. The frequency of these different causes varies with geographic location. Additionally, Cystic fibrosis identifies as a cause in up to half of cases.

Cystic fibrosis

Cystic fibrosis is the most common life-threatening autosomal recessive disease in the United States and Europe. It is a genetic disorder that affects the lungs, but also the pancreas, liver, kidneys, and intestine. In general, It cause by mutations in the CFTR protein, a chloride channel expressed in epithelial cells. Lung disease results from clogging of the airways due to mucus build-up, decreased muco-ciliary clearance, also resulting inflammation. In later stages, changes to the structure of the lung, such asbronchiectasis, occur. Around 5 to 10% of all patients with cystic fibrosis developbronchiectasis.

Airway obstruction

An airway obstruction can cause by either an intraluminal mass such as a tumor or a foreign body. Furthermore, the presence of an airway obstruction leads to a cycle of inflammation. It is important to identify the presence of an obstruction because surgical resection is often curative if obstruction is the cause. In adults, foreign body aspiration often associate with an altered state of consciousness. The foreign body often unchewed food, or part of a tooth or crown. In conclusion, Bronchiectasis that results from foreign body aspiration generally occurs in the right lung in the lower lobe or posterior segments of the upper lobe.

Lung infections

A range of bacterial, mycobacterial, also viral lung infections are associated with the development ofbronchiectasis. Bacterial infections commonly associated withbronchiectasis i.e. P. aeruginosa, H. influenzae, and S. pneumoniae. Gram-negative bacteria more commonly implicate than gram-positive bacteria. A history of mycobacterial infections such as tuberculosis can lead to damage of the airways that predisposes to bacterial colonization. In brief, Severe viral infections in childhood can also lead tobronchiectasis through a similar mechanism. Nontuberculous mycobacteria infections such as Mycobacterium avium complex found to be a cause in some patients. Lastly, Recent studies have also shown Nocardia infections to implicated inbronchiectasis.

Impaired host defences

Impairments in host defenses that lead tobronchiectasis may be congenital, such as with primary ciliary dyskinesia, or acquired, such as with the prolonged use of immunosuppressive drugs. Additionally, these impairments may localized to the lungs, or systemic throughout the body. In these states of immunodeficiency, there a weakened or absent immune system response to severe infections that repeatedly affect the lung and eventually result in bronchial wall injury. HIV/AIDS an example of an acquired immunodeficiency that can lead to the development ofbronchiectasis.

Aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) an inflammatory disease caused by hypersensitivity to the fungus Aspergillus fumigatus. It suspected in patients with a long history of asthma also symptoms ofbronchiectasis such as a productive, mucopurulent cough. Imaging often shows peripheral and central airwaybronchiectasis, which unusual in patients withbronchiectasis caused by other disorders.

Autoimmune diseases

Several autoimmune diseases have associated withbronchiectasis. Specifically, individuals with rheumatoid arthritis and Sjogren syndrome have increased rates ofbronchiectasis. In these diseases, the symptoms ofbronchiectasis usually present later in the disease course. Other autoimmune diseases such as ulcerative colitis and Crohn’s disease also have an association withbronchiectasis. Additionally, graft-versus-host disease in patients who have underwent stem cell transplantation can lead tobronchiectasis as well.

Lung injury

CongenitalBronchiectasis

may result from congenital disorders that affect either cilia motility or ion transport. A common genetic cause cystic fibrosis, which affects chloride ion transport. Another genetic cause is primary ciliary dyskinesia, a rare disorder that leads to immotility of cilia and can lead to situs inversus. When situs inversus accompanied by chronic sinusitis andbronchiectasis, this known as Kartagener’s syndrome. Other rare genetic causes include Young’s syndrome and Williams-Campbell syndrome.

Tracheobronchomegaly, or Mourner-Kuhn syndrome a rare condition characterize by significant tracheobronchial dilation and recurrent lower respiratory tract infections. Individuals with alpha 1-antitrypsin deficiency have found to be particularly susceptible tobronchiectasis, due to the loss of inhibition to enzyme elastase which cleaves elastin. This decreases the ability of the alveoli to return to normal shape during expiration.

Cigarette smoking

A causal role for tobacco smoke inbronchiectasis has not demonstrated. Nonetheless, tobacco smoking worse pulmonary function and accelerate the progression of disease that is already present

Cystic fibrosis, which causes almost half of the cases of bronchiectasis in the United States.
Immunodeficiency disorders, such as common variable immunodeficiency and, less often, HIV and AIDS.
Allergic bronchopulmonary aspergillosis, which is an allergic reaction to a fungus called aspergillus that causes swelling in the airways.
Disorders that affect cilia function, such as primary ciliary dyskinesia, can causebronchiectasis. Cilia are small, hair-like structures that line your airways. They help clear mucus (a slimy substance) out of your airways.
Chronic (long-term) pulmonary aspiration, which can inflame the airways
Connective tissue diseases, such as rheumatoid arthritis, Sjögren’s syndrome external link, and Crohn’s disease.

The diagnostic feature ofbronchiectasis dilate bronchi. The Reid classification differentiates between pathological and radiological appearances ofbronchiectasis.

Cylindricalbronchiectasis i.e.

Bronchial dilatation is mild and the bronchi retain their regular relatively straight outline.
Varicosebronchiectasis
Bronchial dilatation is greater and local constrictions are present, giving the airway an irregular appearance.

Saccular/cystic bronchiectasis i.e.

–is the most severe form and characterize by large areas of distal ‘grape-like’ bronchial dilatation and loss of bronchial subdivision.

Atelectatic bronchiectasis i.e.

-is a localized form related to proximal bronchial distortion or occlusion.

1. Cystic Fibrosis Bronchiectasis

(CFB):

Cystic fibrosis (CF) is a genetic condition that causes thick, sticky mucus to build up in the patient’s lungs, resulting in repeated pulmonary infections. Likebronchiectasis, each cycle of inflammation and infection further damages the bronchi, causing patients to exhibit signs of bronchiectasis. According to the Cystic Fibrosis Foundation, there are more than 30,000 people living with CF in the United States today.

2. Non-Cystic FibrosisBronchiectasis

(NCFB):

Patients can also develop bronchiectasis outside of CF. For instance, if a patient is living with COPD (chronic obstructive pulmonary disease); has damaged cilia (tiny hair-like structures inside the bronchial tube that help clear mucus in the lungs); experiences asthma; or has impaired muscular and nervous system functions that prevent them from clearing mucus naturally, they may develop bronchiectasis-related symptoms.
Reid categorized bronchiectasis as having three main phenotypes:
1) tubular characterized by smooth dilation of the bronchi.
2) varicose in which the bronchi are dilated with multiple indentations; and
3) cystic in which dilated bronchi terminate in blind ending sacs.

Attacks of recurrent bronchitis, more common in winter. Clubbing of fingers diagnostic.

Hemorrhagic (bronchiectasis sicca) –

Recurrent hemoptysis with good health in-between, or attacks of bronchitis.

Suppurative – For instances; Chronic cough, copious purulent expectoration, general toxemia, clubbing of fingers varying from slight parrot beak curvature of finger nails to bulbous drum stick enlargement (pulmonary osteoarthropathy).

During exacerbations, Dyspnoea and wheezing occur in 75% of patients and pleuritic chest pain in 50%. Pleuritic chest pain cause by distended peripheral airways and inflammation adjacent to the visceral pleura. Pyrexia rare during exacerbations; if it is present, pneumonia should exclude

With relatively rapid onset –

Symptoms developing with comparative suddenness, as a sequel to partial bronchial obstruction by a foreign body or after anesthesia. In early stages paroxysmal cough with occasional offensive sputum which may provoke by change of position. Later large amounts of fetid sputum. Signs mostly limited to auscultation and depend on the size of the affected bronchi, patency of the airways and viscosity of secretions. There may signs of (a) bronchitis, or (b) fibrosis, or (c) consolidation, or (d) collapse, or (e) of cavitation’s.

Early stages –

Fine crackles or sticky rhonchi and slight alteration in character of breath sounds.

Late stages –

Bronchial breathing, coarse crept and perhaps signs of a cavity. Changing character of physical signs after a long bout of cough when air entry may become louder and bronchial in character or from day to day. Sharp metallic or “leathery” rales characteristic. Recurrent pneumonia in the same area of the lung classically associate withbronchiectasis.

Subjective assessment:

History of childhood infection or childhood respiratory symptoms
Family history ofbronchiectasis, especially cystic fibrosis
Smoking history
Presence of symptoms to suggest a systemic inflammatory disorder (joint problems, skin rash, muscle pain)
Duration and severity of symptoms
Frequency of infective exacerbations.

Objective clinical examination:

Peripheral examination for signs of chronic lung disease e.g nail changes (clubbing) occur in some forms ofbronchiectasis
Cough quality, strength and sputum production
Signs to suggest a systemic inflammatory disorder (joints, skin, muscles, eyes)
Listening to the chest. Bronchiectasisis characterised by focal or generalised noises (crepitations, wheeze) heard with the stethoscope.

SPUTUM EXAMINATION –

To exclude diagnosis of underlying pulmonary tuberculosis. Culture and sensitivity of infecting organism as a guide to chemotherapy.

RADIOLOGY:

Sinus radiographs – for chronic sinusitis.

Chest radiography – for changes suggestive or associated with the diagnosis.

Collapse (either segmental or lobar)

Crowding of pulmonary vessels, indicating area of damage or consolidation that may become infected. • ‘Tramline shadows’ suggesting bronchial wall oedema.

Cystic lesions suggesting saccularbronchiectasis

Evidence of previous tuberculosis.

Evidence of previous heart surgery.

HRCT–

High-resolution CT has replaced bronchography and is the preferred investigation. CT findings include the following: – The ‘signet ring’ sign (end-on dilated bronchi that are larger than the accompanying pulmonary artery) seen in all form ofbronchiectasis

Tramlines (in other words, non-tapering bronchi) seen in cylindrical bronchiectasis – Varicosebronchiectasis has a beaded (tree-imbued) appearance – ‘Cysts’ with air-fluid levels in dilated bronchi characteristic of cysticbronchiectasis SPIRAL CT may aid diagnosis by reducing motion artefact and identifying subtle bronchiectasis changes.

SPECIAL INVESTIGATIONS:

may indicate the cause of bronchiectasis in some patients.

Immunoglobulins –

Most patients with bronchiectasis have raised plasma concentrations of immunoglobulins (especially IgA).

Aspergillus precipitins –

Recurrent mucus plugging of major airways and development of proximal bronchiectasis occurs in allergic bronchopulmonary aspergillosis.

Barium studies –

For gastro-esophageal reflux, since association of basalbronchiectasis is well recognized.

a1-antitrypsin deficiency associate with premature pulmonary emphysema though rarely in association withbronchiectasis.

Detection of cystic fibrosis –

By sweat test and/or genetic analysis

COPD
Asthma
Pneumonia
Tuberculosis
Chronic sinusitis
Lung cancer
Postnasal drip
Inhaled foreign body.

Quit smoking and avoid secondhand smoke.
Maintain a healthy diet, low in sodium, added sugars, saturated fats and refined grains.
Stay hydrated, drinking plenty of water to help prevent mucus build-up.
Be diligent about taking oral and inhaled medications and performing mucus clearance techniques daily.
Staying up to date on vaccinations.
Take antibiotics for one to two weeks during flare-ups.
Despite maintaining a healthy lifestyle, occasional flare-ups may occur . This often happens because of a new respiratory infection or overgrowth of bacteria. Symptoms such as increased mucus (sputum) production that is bloody or a different color, fever, fatigue, weight loss and worsening shortness of breath may be a sign you’re experiencing a flare-up. In these instances, you should contact your doctor immediately.

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Homeopathic Remedies for Bronchiectasis

Antimonium Tartaricum: This remedy is often indicated for individuals with bronchiectasis who experience excessive mucus production, rattling cough, and difficulty expectorating mucus. It helps relieve congestion and improve breathing.

Hepar Sulphuris Calcareum: Hepar Sulphuris Calcareum is beneficial for individuals with bronchiectasis who experience chest pain, coughing fits, and sensitivity to cold air. It helps reduce inflammation and promote healing of the bronchial tubes.

Pulsatilla: Pulsatilla is recommended for individuals with bronchiectasis who experience a changeable cough with thick, yellow-green mucus that worsens at night. It helps alleviate coughing spasms and promote expectoration.

Silicea: Silicea is indicated for individuals with bronchiectasis who experience recurrent respiratory infections and weakened immunity. It helps strengthen the immune system and prevent further infections.

Kali Carbonicum: Kali Carbonicum is useful for individuals with bronchiectasis who experience shortness of breath, especially on exertion, and coughing with yellow-green mucus. It helps improve lung function and reduce respiratory symptoms.

Our homeopathic remedies are safe, gentle, and free from side effects, making them suitable for long-term use and individuals of all ages, including children and pregnant women.

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Use a diet with 1.0–1.25 g protein/kg and sufficient calories to meet elevated metabolic requirements appropriate for age and sex.
Small, frequent feedings may better tolerate.
Fluid intake of 2–3 L daily may offer, unless contraindicated.
Intravenous fat emulsions may indicate (eicosanoids are inflammatory modulators, and thromboxane and leukotrienes tend to be potent mediators of inflammation). Omega-3 fatty acids should enhance in the oral diet by including salmon, tuna, sardines, walnuts, and flaxseed. Supplements may also useful.
Adequate antioxidant use with vitamins C and E and selenium may beneficial. Ensure adequate potassium intake, depending on medications used.

Pulmonary – recurrent pneumonia
Lung abscess
Haemoptysis
Empyema
Septicemia
Cor pulmonale
Respiratory failure
Secondary amyloidosis with nephrotic syndrome
Recurrent pleurisy.

What is Bronchiectasis?

What are the symptoms of Bronchiectasis?

Bronchitis- Clubbing of fingers
Hemorrhagic Hemoptysis
Suppurative- Chronic cough, Copious purulent expectoration
Dyspnea and wheezing
Paroxysmal cough

What are the causes of Bronchiectasis?

Cystic fibrosis
Airway obstruction
Lung infections
Impaired host defenses
Aspergillosis
Autoimmune diseases
Lung injury
Congenital
Cigarette smoking

[1] Golwalla’s MEDICINE for Students 25^th Edition

[2] Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies

[3] Nutrition and Diagnosis-Related Care (Nutrition and Diagnosis-Related Care (Escott-Stump)

[4] https://www.nhlbi.nih.gov/health/bronchiectasis/causes

[5] https://smartvest.com/blog/understanding-types-bronchiectasis/#:~:text=According%20to%20the%20CHEST%20Foundation,cystic%20fibrosis%20bronchiectasis%20(NCFB)

[6] https://bronchiectasis.com.au/assessment/medical/clinical-examination

[7] https://www.google.com/search?q=bronchiectasis+differential+diagnosis&newwindow

[8] https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/treating-and-managing

Bronchiectasis :10 Powerful Homeopathic Remedies