Causes of bronchiectasis

[marie50]

My 83-year-old mother was just diagnosed with bronchiectasis after a major episode of coughing up blood sent her to the ER. Diagnosis was made on the basis of a CT scan. She claims to have no other symptoms of bronchiectasis such as chronic cough or abnormal mucus production. Her pulmonologist believes this condition was caused by an infection in early childhood that permantently damaged her bronchial tubes. She doesn't remember having a severe infection as a child, but as an adult, has had two episodes of "walking pneumonia" and bronchitis numerous times. Nine years ago, she had a moderate case of pertussis which she acquired from my son. Is it possible this infection caused her bronchiectasis, since pertussis is often implicated in the development of the condition?

The pertussis/bronchiectasis connection is also a concern for me since my son and I both had severe cases of pertussis (diagnosed too late for antibiotics to help.) What are the chances we may have permanent bronchial damage but have not yet become symptomatic? We both have early onset asthma and a lifetime history of lower respiratory infections. I doubt any doctor would order a CT scan just to ease my worries, but I would like to know now if we have bronchial damage so we can be prepared for what may come later. Any advice?

[National Jewish]

Bronchiectasis can develop at any age.  Inflammation causes damage to the airways of the lungs.  When the airways become dilated this is called bronchiolectasis.  When the airways become distorted with areas where mucus can collect this is called bronchiectasis.  This can certainly be due to a lung infection during childhood, but it can follow lung infections as an adult especially severe pneumonia or repeated lung infections such as bronchitis.  In fact, in recent years, a correlation has been found between a lung infection with the nontuberculous mycobacterium called Mycobacterium avium complex (MAC) and the development of bronchiectasis primarily in post-menopausal women.  When a person’s immune system is compromised, then they may be more likely to develop bronchiectasis due to an otherwise unusual organism, such as fungi.  So it would be important that your mother's sputum be cultured for nontuberculous mycobacteria as well as fungi.  Although there is a real chance that either you or your son have permanent lung damage from pertussis, that chance is small.

Usually these changes can be seen with a CT scan of the lungs.  It can be difficult to clear this mucus because of damage to the normal methods that the lungs use to clear mucus.  This can lead to numerous episodes of infection.  Typically an ongoing infection can lead to inflammation.  So it is important that lung infections are treated.  Pulmonary hygiene is very important in preventing and controlling lung infections.  Using an inhaled bronchodilator may help to loosen the mucus.  Many people find the routine use of a mucus clearance device to be very helpful in clearing the mucus from their lungs.  This is a small device that you exhale into causing a vibration in your lungs that loosens mucus so that you can cough it up easier.  The names of 2 types of devices are Acapella and Flutter Valve.  Bronchiectasis can result from airway blockage along with infection, so it may effect only one area of the lung.  If the recurrent lung infections are always in the same area of the lung, surgery to remove that portion of the lung may provide a cure.  Please read our bronchiectasis information at http://www.nationaljewish.org/disease-info/diseases/bronchiectasis/index.aspx to learn more.