Friday, January 20, 2006

Bronchiectasis consult

We have received this question from one of our readers:
I'm a 32 year-old man, having Minimal bronchiectatic changes since the childwood, I've undergone several types of medicines prescribed by several doctors though out my life.
Also I've undergone CT Scan at the age of 28, result is as follows,
Impression: CT Findings suggest minimal bronchiectatic changes involving apical segments of lower lobes, basal segments of left lower lobe, lateral basal segment of right lower lobe and apico-posterior segment of left upper lobe.
Right now I'm taking following medicine,
Tiova inhaler - ((Generic Spiriva) daily 2 dose.
Salbutomol - 100 - 2 times a day - 2 dose.
whenever I get lungs infection - antibiotic tablets for 5 days.
Daily minimum sputum will come out.
If lungs infection has happened due to outside dust polution & cold - sputum will be more & fever.
usually I get lungs infection in 1 1/2 months - 2 months of times. also I take higher antibiotic tablet is infection resist to current auntibiotic tablet.
Is there is any way to get rid of this problem and can live as normal human being?
I can't eat/drink cold items, can't spending in warm water, etc..
it will be greatful if you suggest for any permanent solution for this, so that I can get cure and lead the life with peace.

7 comments - CLICK HERE to read & add your own!:

Baleeiro said...

Thank you for your question.
Treatment of bronchiectasis is a fairly complex area since there are several different strategies.
First let me suggest that everyone with bronchiectasis should be seen, if possible, by a pulmonary specialist at least once for formal pulmonary function testing, evaluation of the cause and infectious flora involved with the bronchiectasis.
The cornerstones of treatment include control of infection and improved bronchial hygiene to prevent acute exacerbations and worsening function.
Surgery can be a very good option for localized disease (only one lobe in one side) which is not your case here...
Since infection plays a major role in causing and perpetuating bronchiectasis, reducing the microbial load is very important. It seems in this case that you have quite frequent episodes of infection. One simple intervention would be to obtain cultures from sputum samples to look for resistant organisms that are not being controlled with regular antibiotics or unusual stuff like non-tuberculous mycobacteria (your local pulmonologist would be able to test you for that).

Baleeiro said...

The next possible intervention is chronic microbial suppression with scheduled or cyclic antibiotics. There is limited data on this outside of Cystic Fibrosis cases but this is a fairly useful practice consisting of daily antibiotic therapy (oral in most cases or even aerossolized in more complicated ones) given for seven to 14 days of each month. This would reduce the burden of infection and minimize exacerbations and the chronic symptoms you describe.

Baleeiro said...

Pulmonary hygiene is the next very important strategy. It involves physical means to improve drainage/clearance of the secretions. Good hydration and frequent use of chest percussion and postural (which can be arranged through and taught by a respiratory service) will greatly help with symptoms.
I will let my colleagues add more ideas and post more soon.

Mike L said...

Carlos' suggestions are, as usual, all inclusive. There is very little to add.
Historically, the cause of early adulthood bronchiectasis was pertussis. I assume that you have received your appropriate vaccinations currently. I would also make a case for a yearly flu vaccine and a pneumovax every 5-10 years given your frequent respiratory infections.
Looking for alternative causes of bronchiectasis (Cystic fibrosis, non-tuberculous mycobacteria and allergic bronchopulmonary mycosis) would be in your best interest as these are not treated, for the most part, with typical antimicrobials.

Thanks for the opportunity to discuss this process.

Jeff H said...

I agree with the comments from Dr. Baleeiro. Additionally, I will add that for some patients, cyclic antibiotics (14 days on/14 days off) may not be adequete, and some patients require chronic supressive antibiotic therapy. In those cases, it may be best to actually rotate the antibiotic used (i.e. Augmentin for one month, then Zithromax for one month, then a quinolone for a month, then back to Augmentin). This strategy may help to reduce the emergence of resistant bacteria.

I agree with sputum culture/sensativities to direct future antibiotic therapy.

Finally, I agree with the emphasis on seeing a pulmonologist. For a young patient with bilateral bronciectasis of unknown etiology, further evaluation is recommended, as there may be an underlying immunodeficiency (Immunoglobulin deficiency, cystic fibrosis, chronic granulomatous disease, dysmotile cilia syndrome) or infection (atypical mycobacterium, as noted).

Thanks for your question, and we welcome comments from any/all pulmonologists, infectious disease docs,internists, family physicians, medical students, and patients with bronchiectasis!

Jeff H said...
This comment has been removed by a blog administrator.
Anonymous said...

I am a 48 year old female who has had bronciectasis since I was 11 years old. I took up running when I was 17 years old in order to help my disorder. I have run in 18 City to Surf races, which is a 14klm fun run in Sydney Australia. I do 10 minutes of posturual drainage each day. I do not get blood in my sputum. The specialist said my immunity was moderately affected. When I feel I have a chest infection, my doctor gets my sputum checked and I usually have to take augmentun.This usually happens in winter. I developed mild assma 3 years ago, which I use a preventative Symbicort . I exercise 5 times a week and eat a very healthy diet. Besides my cronic cough, my bronciectasis is under control. Postural drainage for me is imperative. When I was diagnosed with bronciectasis, I remember the specialist telling me IT WAS IMPERATIVE for me to do postural drainage everyday without fail, and so I have. I also feel the running has contributed to my good health. I feel you must be pro-active in helping yourself when you have a health issue and to research and find information that may help you.Hope you will find this information useful. Good health and good luck. Regards Joanne.