Suppurative Lung Disease Including Bronchiectasis

What is Bronchiectasis?

  • Bronchiectasis or suppurative lung disease is a condition where the airways inside the lungs gets dilated. The lining inside the airways also gets diseased and swollen. As a result a lot of mucus gets trapped inside these dilated airways. This extra mucus leads to frequent infections in the lungs.
  • These infections lead to further damage to the airways. This cycle continues leading to significant damage to the airways.

How is bronchiectasis different from bronchial asthma?
Although children with asthma and bronchiectasis can have similar symptoms cough and wheezing the two conditions are quite different. In children with asthma the airways are inflamed, have a lot of mucus and the muscles around the airways tighten called as bronchospasm but they are not dilated and damaged. Some children can have both asthma and bronchiectasis.

What are the causes of childhood bronchiectasis?
More common causes of bronchiectasis includes a bad pneumonia, tuberculosis (TB), whooping cough or measles infection in the past leading to damage to the airways. Other less common causes of bronchiectasis in children includes cystic fibrosis, primary ciliary dyskinesia, immune-deficiency (most commonly common variable immunodeficiency, X-linked agammaglobulinemia), HIV and allergic bronchopulmonary aspergillosis.

What are the signs and symptoms of bronchiectasis in children?

  • Children with bronchiectasis have a wet sounding cough lasting for weeks to months. This is due to the extra mucus or phlegm in the airways. Sometimes, cough can be associated with blood in the sputum or phlegm (also called as hemoptysis). Some children with bronchiectasis can have wheezing sounds similar to children with asthma. Children with bronchiectasis can have poor weight gain and do not gain adequate height.
  • Children with bronchiectasis also develop exacerbations or flares. During these periods cough get worse, the phlegm change colour from clear to yellow or dark green, breathing gets fast and child gets fever.

What investigations are required in children with bronchiectasis?

  • Chest Xray might be suggestive but may not be able to confirm the diagnosis of bronchiectasis. CT Scan chest is required to confirm the diagnosis of bronchiectasis.
  • Additional tests are required for evaluating the underlying cause of bronchiectasis. This includes: immune deficiency workup, HIV, workup for tuberculosis, tests for allergic bronchopulmonary aspergillosis and sweat chloride analysis etc.
  • Further investigations which might be required are: flexible bronchoscopy, sputum cultures, pulmonary function testing etc.

How do we treat bronchiectasis?
Chest physiotherapy and antibiotics for infections are the mainstay of bronchiectasis treatment. Treatment of the underlying cause of bronchiectasis is essential to halt the progression of disease.

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