Bronchiectasis Health Dictionary

A radiographic procedure using a radio-opaque substance injected into the bronchial tree to show its outline. This is a simple procedure carried out under general anaesthesia and allows the accurate location of, for example, a lung ABSCESS, BRONCHIECTASIS, or a TUMOUR in the lung.... bronchography

The term applied to the thickening and broadening of the ?ngertips – and, less commonly, the tips of the toes – that occurs in certain chronic diseases of the lungs and heart. It is due to interstitial OEDEMA especially at the nail bed, leading to a loss of the acute angle between the nail and the skin of the ?nger. Clubbing is associated with lung cancer, EMPYEMA, BRONCHIECTASIS and congenital cyanotic heart disease.... clubbing

This is the most common serious genetic disease in Caucasian children, with an incidence of about one per 2,500 births, and more than 6,000 patients in the UK (30,000 in the USA). It is an autosomal recessive disorder of the mucus-secreting glands of the lungs, the pancreas, the mouth, and the gastrointestinal tract, as well as the sweat glands of the skin. The defective gene is sited on chromosome 7 which encodes for a protein, cystic ?brosis transmembrane conductance regulator (CFTR). Individuals who inherit the gene only on one set of chromosomes can, however, carry the defect into successive generations. Where parents have a child with cystic ?brosis, they have a one-infour chance of subsequent children having the disease. They should seek GENETIC COUNSELLING.

The disorder is characterised by failure to gain weight in spite of a good appetite, by repeated attacks of bronchitis (with BRONCHIECTASIS developing at a young age), and by the passage of loose, foul-smelling and slimy stools (faeces). AMNIOCENTESIS, which yields amniotic ?uid along with cells shed from the fetus’s skin, can be used to diagnose cystic ?brosis prenatally. The levels of various enzymes can be measured in the ?uid and are abnormal when the fetus is affected by cystic ?brosis. Neonatal screening is possible using a test on blood spots – immunoreactive trypsin (IRT).

In children with symptoms or a positive family history, the disease can be tested for by measuring sweat chloride and sodium. This detects the abnormal amount of salt that is excreted via the sweat glands when cystic ?brosis is present. Con?rmation is by genetic testing.

Treatment This consists basically of regular physiotherapy and postural drainage, antibiotics and the taking of pancreatic enzyme tablets and vitamins. Some children need STEROID treatment and all require nutritional support. The earlier treatment is started, the better the results. Whereas two decades ago, only 12 per cent of affected children survived beyond adolescence, today 75 per cent survive into adult life, and an increasing number are surviving into their 40s. Patients with end-stage disease can be treated by heart-lung transplantation (with their own heart going to another recipient). Research is underway on the possible use of GENE THERAPY to control the disorder. Parents of children with cystic ?brosis, seeking help and advice, can obtain this from the Cystic Fibrosis Trust.... cystic fibrosis

The medical term for bad breath. Halitosis is usually a result of smoking, drinking alcohol, eating garlic or onions, or poor oral hygiene. Persistent bad breath not caused by any of these may be a symptom of mouth infection, sinusitis, or certain lung disorders, such as bronchiectasis.... halitosis

A disease caused by invasion of the lung by the fungus, Aspergillus fumigatus. The infection is acquired by inhalation of air-borne spores of the fungus, which settle and grow in damaged parts of the lung such as healed tuberculous cavities, abscesses, or the dilated bronchi of BRONCHIECTASIS.... aspergillosis

Attacks of uncontrollable coughing or “whooping”, often relating to whooping cough or bronchiectasis, but they can also be caused by the smoke from burning plastics and (memories of yesteryear) hash oil.... cough, paroxysmal

The operation of cutting out a lobe of the lung in such diseases as abscess of the lung and bronchiectasis and carcinoma (see LUNGS, DISEASES OF).... lobectomy

In?ammation of the PLEURA or serous membrane investing the lung and lining the inner surface of the ribs. It is a common condition, and may be either acute or chronic, the latter being usually tuberculous in origin (see TUBERCULOSIS).

Many cases of pleurisy are associated with only a little e?usion, the in?ammation consisting chie?y in exudation of FIBRIN: to this form the term ‘dry pleurisy’ is applied. Further, pleurisy may be limited to a very small area – or, on the contrary, may affect, throughout a greater or less extent, the pleural surfaces of both lungs.

Causes Pleurisy is often associated with other forms of in?ammatory disease within the chest, more particularly PNEUMONIA, BRONCHIECTASIS, and tuberculosis; it occasionally accompanies PERICARDITIS. It may also be due to carcinoma of the lung, or be secondary to abdominal infections such as subphrenic abscess. Further, wounds or injuries of the thoracic walls are apt to set up pleurisy.

Symptoms The symptoms of pleurisy vary, being generally well marked, but sometimes obscure. DRY PLEURISY In the case of dry pleurisy, which is, on the whole, the milder form, the chief symptom is a sharp pain in the side, felt especially on breathing. Fever may or may not be present. There is a slight, dry cough, and breathing is quicker than normal and shallow. PLEURISY WITH EFFUSION is usually more severe than dry pleurisy, and, although it may in some cases develop insidiously, it is in general ushered in sharply by shivering and fever, like other acute in?ammatory diseases. Pain is felt in the side or breast, of a severe cutting or stabbing character. A dry cough usually occurs and breathing is painful and di?cult.

Treatment The treatment varies greatly with the form and severity of the attack. Bed rest, antibiotics, analgesics and antipyretics are advisable. A large pleural e?usion may need to be drained via an aspiration needle.... pleurisy

The operation of removing an entire lung (see LUNGS) in such diseases as BRONCHIECTASIS, TUBERCULOSIS, and cancer of the lung.... pneumonectomy

Facilitation of the drainage of secretions from dilated bronchi of the LUNGS. The patient lies on an inclined plane, head downwards, and is encouraged to cough up as much secretion from the lungs as possible. The precise position depends on which part of the lungs is affected. It may need to be carried out for up to three hours daily in divided periods. It is of particular value in BRONCHIECTASIS and lung abscess (see LUNGS, DISEASES OF).... postural drainage

Various conditions affecting the LUNGS are dealt with under the following headings: ASTHMA; BRONCHIECTASIS; CHEST, DEFORMITIES OF; CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD); COLD, COMMON; EMPHYSEMA; EXPECTORATION; HAEMOPTYSIS; HAEMORRHAGE; OCCUPATIONAL HEALTH, MEDICINE AND DISEASES; PLEURISY; PNEUMONIA; PULMONARY EMBOLISM; TUBERCULOSIS.

In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.

Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.

Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).

Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.

Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.

Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously

– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.

Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.

The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.

Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.

Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.

Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of

The mucous secretions from the mouth, throat or back of the nose. Sputum is also expectorated by coughing from the lower air passages. Its production may be increased by respiratory-tract allergy (ASTHMA) or by breathing-in irritants such as tobacco smoke, smoke from a ?re, or fumes from chemical materials. Sputum is normally white, but infection will turn it to yellow or green, and blood from the lungs may produce pink frothy sputum. Treatment is to deal with the underlying disorder. Production of large quantities of sputum – for instance, in BRONCHIECTASIS – may require physiotherapy and postural drainage. (See also EXPECTORATION.)... sputum

Herbs that expand the clear space within the bronchial tubes, thus opening-up airways and relieving obstruction. Effective for asthma, bronchitis, emphysema. May help cystic fibrosis, bronchiectasis and relieve cough. Ephedra, Euphorbia hirta, Lobelia, Mouse Ear, Sundew, White Horehound, White Squills, Wild Thyme. ... bronchodilators

Pneumonia is an in?ammation of the lung tissue (see LUNGS) caused by infection. It can occur without underlying lung or general disease, or in patients with an underlying condition that makes them susceptible.

Pneumonia with no predisposing cause – community-acquired pneumonia – is caused most often by Streptococcus pneumoniae (PNEUMOCOCCUS). The other most common causes are viruses, Mycoplasma pneumoniae and Legionella species (Legionnaire’s disease). Another cause, Chlamydia psittaci, may be associated with exposure to perching birds.

In patients with underlying lung disease, such as CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) or BRONCHIECTASIS as in CYSTIC FIBROSIS, other organisms such as Haemophilus in?uenzae, Klebsiella, Escherichia coli and Pseudomonas aeruginosa are more prominent. In patients in hospital with severe underlying disease, pneumonia, often caused by gram-negative bacteria (see GRAM’S STAIN), is commonly the terminal event.

In patients with an immune system suppressed by pregnancy and labour, infection with HIV, CHEMOTHERAPY or immunosuppressive drugs after organ transplantation, a wider range of opportunistic organisms needs to be considered. Some of these organisms such as CYTOMEGALOVIRUS (CMV) or the fungus Pneumocystis carinii rarely cause disease in immunocompetent individuals – those whose body’s immune (defence) system is e?ective.

TUBERCULOSIS is another cause of pneumonia, although the pattern of lung involvement and the more chronic course usually di?erentiate it from other causes of pneumonia.

Symptoms The common symptoms of pneumonia are cough, fever (sometimes with RIGOR), pleuritic chest pain (see PLEURISY) and shortness of breath. SPUTUM may not be present at ?rst but later may be purulent or reddish (rusty).

Examination of the chest may show the typical signs of consolidation of an area of lung. The solid lung in which the alveoli are ?lled with in?ammatory exudate is dull to percussion but transmits sounds better than air-containing lung, giving rise to the signs of bronchial breathing and increased conduction of voice sounds to the stethoscope or palpating hand.

The chest X-ray in pneumonia shows opacities corresponding to the consolidated lung. This may have a lobar distribution ?tting with limitation to one area of the lung, or have a less con?uent scattered distribution in bronchopneumonia. Blood tests usually show a raised white cell (LEUCOCYTES) count. The organism responsible for the pneumonia can often be identi?ed from culture of the sputum or the blood, or from blood tests for the speci?c ANTIBODIES produced in response to the infection.

Treatment The treatment of pneumonia involves appropriate antibiotics together with oxygen, pain relief and management of any complications that may arise. When treatment is started, the causative organism has often not been identi?ed so that the antibiotic choice is made on the basis of the clinical features, prevalent organisms and their sensitivities. In severe cases of community-acquired pneumonia (see above), this will often be a PENICILLIN or one of the CEPHALOSPORINS to cover Strep. pneumoniae together with a macrolide such as ERYTHROMYCIN. Pleuritic pain will need analgesia to allow deep breathing and coughing; oxygen may be needed as judged by the oxygen saturation or blood gas measurement.

Possible complications of pneumonia are local changes such as lung abscess, pleural e?usion or EMPYEMA and general problems such as cardiovascular collapse and abnormalities of kidney or liver function. Appropriate treatment should result in complete resolution of the lung changes but some FIBROSIS in the lung may remain. Pneumonia can be a severe illness in previously ?t people and it may take some months to return to full ?tness.... pneumonia

The most common lung disorders are infections. These diseases include pneumonia, tracheitis, and croup. Bronchitis and bronchiolitis, which are inflammatory disorders affecting the airways within the lungs, can be complications of colds or influenza. The disorder bronchiectasis may occur as a complication of severe bacterial pneumonia o.

cystic fibrosis. The lungs can also be affected by allergic disorders. The most important of these is asthma. Another such disorder is allergic alveolitis, which is usually a reaction to dust of plant or animal origin. Irritation of the airways, usually by tobacco-smoking, can cause diseases characterized by damage to lung tissue and narrowing of the airways (see pulmonary disease, chronic obstructive). The lungs can also be affected by cancerous tumours; lung cancer is one of the most common cancers. Noncancerous lung tumours are uncommon.

Injury to a lung, usually resulting from penetration of the chest wall, can cause the lung to collapse (see pneumothorax; haemothorax). Damage to the interior of the lungs can be caused by inhalation of toxic substances (see asbestosis; silicosis). Blood supply to the lungs may be reduced by pulmonary embolism.

Lung disorders can be investigated in various ways, such as chest X-ray, bronchoscopy, and pulmonary function tests.... lung, disorders of

a hereditary condition in which the heart and other internal organs lie on the opposite side of the body to the norm (i.e. the heart lies on the right; see dextrocardia); it is associated with chronic sinusitis and bronchiectasis. [M. Kartagener (1897–1975), German physician]... kartagener’s syndrome

an abnormal build-up of *keratin and dead skin cells within the ear canal that can block the canal, cause conductive hearing loss (see deafness), and erode the bone of the ear canal. It is associated with *bronchiectasis and chronic sinusitis.... keratosis obturans

A highly contagious infectious disease, also called whooping cough, which mainly affects infants and young children. The main features of the illness are bouts of coughing, often ending in a characteristic “whoop”. The main cause is infection with BORDETELLA PERTUSSIS bacteria, which are spread in airborne droplets.

After an incubation period of 7–10 days, the illness starts with a mild cough, sneezing, nasal discharge, fever, and sore eyes. After a few days, the cough becomes more persistent and severe, especially at night. Whooping occurs in most cases. Sometimes the cough can

cause vomiting. In infants, there is a risk of temporary apnoea following a coughing spasm. The illness may last for a few weeks. The possible complications include nosebleeds, dehydration, pneumonia, pneumothorax, bronchiectasis (permanent widening of the airways), and convulsions. Untreated, pertussis may prove fatal.

Pertussis is usually diagnosed from the symptoms. In the early stages, erythromycin is often given to reduce the child’s infectivity. Treatment consists of keeping the child warm, giving small, frequent meals and plenty to drink, and protecting him or her from stimuli, such as smoke, that can provoke coughing. If the child becomes blue or persistently vomits after coughing, hospital admission is needed.

In developed countries, most infants are vaccinated against pertussis in the 1st year of life. It is usually given as part of the DPT vaccination at 2, 3, and 4 months of age. Possible complications include a mild fever and fretfulness. Very rarely, an infant may have a severe reaction, with high-pitched screaming or seizures.... pertussis

an acute highly infectious disease usually caused by the bacterium Bordetella pertussis, primarily affecting infants and often occurring in epidemics. After an incubation period of 1–2 weeks there is a catarrhal stage, in which the infant has signs of an upper respiratory tract infection; transmission is through droplet spread. This is followed by an irritating cough that gradually becomes paroxysmal within 1–2 weeks. The paroxysms are followed by a characteristic *whoop and vomiting. In the very young the classical whoop may not develop and instead the paroxysms may be followed by periods of *apnoea. The illness can last 2–3 months, giving it the name ‘the cough of 100 days’ in some countries. Infection can be complicated by bronchopneumonia, weight loss due to repeated vomiting, *bronchiectasis, and convulsions due to *asphyxia or bleeding into the brain tissue. Minor complications include subconjunctival haemorrhage, *epistaxis (nosebleed), facial *oedema, and ulceration of the tongue.

*Immunization against the infection was introduced in the UK in the 1950s and offers protection. An attack usually confers lifelong immunity. Despite good vaccine coverage resulting in the current low levels of disease, whooping cough is still a significant cause of illness and death in the very young. Medical name: pertussis.... whooping cough