KIM’S KORNER- Breathless

Respiratory conditions are on the rise. The most common are fairly well known, such as asthma and bronchitis, but there are many others that are poorly understood. One of them is known as bronchiectasis but before we go on to describe exactly what it is, let us have a quick look at the lungs to get a better understanding of these three similar but quite different conditions.

All three involve changes to the bronchi and bronchioles.  As we breathe in, air enters through the nose or mouth and travels down the trachea (windpipe). The trachea divides into two as it enters the lungs. These branches are known as the bronchi, one into the left lung and one into the right.  Inside the lungs, the bronchi further divide into smaller branches called bronchioles, supplying air to the lungs. The bronchi are compromised in all three conditions. With asthma, the bronchi and bronchioles are narrowed, either due to an allergic reaction or exercise. This condition is reversible with rest or medication.  In bronchitis the bronchi become inflamed, usually due to an infection.

Bronchiectasis is permanent, irreversible widening of the bronchi, usually as a response to repeated respiratory tract infections or congenital or hereditary conditions. Bronchiectasis can sometimes be confused with, or mistaken for, Chronic Obstructive Pulmonary Disease (COPD), a term used to describe conditions that are caused by smoking, pollutants or allergies. The symptoms are similar but the causes are very different.

Bronchiectasis has been linked to smoking but it is not the only cause; it is often present in conditions such as cystic fibrosis, rheumatoid arthritis and HIV, and after diseases like whooping cough, TB and measles. It is an age-related disease, more prevalent in the elderly. The exact numbers worldwide are unknown, mainly because the symptoms vary and diagnosis is not always given. However, it is estimated that 25 per 100,000 people have it. This figure rises to 272 per 100,000 in those over the age of 74. The symptoms of bronchiectasis do not appear overnight and may take months, even years, to develop. The most common symptoms are:

• Chronic daily cough which often produces large amounts of thick mucus

• Coughing up blood

• Wheezing and crackles in the chest when breathing in and out

• Shortness of breath

• Chest pain

• Weight loss

• Fatigue

• Clubbing of fingernails and toenails 

• Recurring respiratory infections

If you have any symptoms, or suspect you may be suffering from this condition, you need to consult your healthcare provider/doctor. The first thing he or she will do is listen to your chest/lungs for abnormal sounds, and send off a sputum sample to test for viruses, fungi or bacteria. 

They may also check how well the air flows into your lungs and send you for an X-ray or CT scan. If these tests still do not confirm a diagnosis, they will perform advanced tests to ascertain the cause of your symptoms. There is no cure so the aim is to minimise further lung damage and keep the airways clear from secretions. A common treatment option is physiotherapy which can help to keep the airways clear through breathing exercises and special techniques to loosen the secretions from the lining of the lungs. A physiotherapist can also advise on exercise and staying fit. Having stronger muscles and greater aerobic capacity makes your body more efficient in the use of oxygen.

Medications are often prescribed to prevent and treat infections. You may be given bronchodilators to make breathing easier. Cough medicines and vaccinations are also used to combat the symptoms. Oxygen therapy is used if you experience shortness of breath and low oxygen saturation. Lack of oxygen can lead to fatigue and a further decline in fitness.

Although bronchiectasis is not curable, there are steps you can take to improve your quality of life. If you are a smoker, the first step is to stop, therefore preventing further damage. Changing your daily lifestyle habits—adopting a healthy diet and exercising—can also help to keep you fit and ready to tackle everyday tasks.