Consumer Information

Bronchiectasis In Children

GENERAL INFORMATION:

What is bronchiectasis?

Bronchiectasis is a lung condition where your child's bronchi become too wide and build up mucus in them. Your child's bronchi are medium-sized airways (tubes) that carry air in and out of his lungs. Your child's lungs make mucus to trap and remove germs and irritants that he breathes in. The mucus made in his lungs is also called phlegm. Your child's airways are lined with ciliated cells that help move the mucus out of his lungs. The cilia are fine, hair-like structures on the cells that move back and forth. These ciliated cells sweep the mucus upward in your child's airways to move it out of his lungs.
With bronchiectasis, your child's airways are damaged and he will have trouble clearing the mucus out. The mucus stays in his airways and germs may grow in it, causing new and repeated lung infections. Over time, this may cause your child's airways to swell, stretch out, and scar. His airways may become so damaged it may get harder for him to move air through them. This damage may happen in one area of his lungs or in many areas of his lungs. There is no cure for bronchiectasis, treatment is aimed at preventing more damage from infections. Treatment may help to prevent your child's symptoms from getting worse.

What causes bronchiectasis? The exact cause of your child's bronchiectasis may be unknown. Bronchiectasis may occur when your child has repeated infections and inflammation (swelling) in his lungs. Inflammation leading to bronchiectasis can be caused by diseases that affect the lungs and by past lung infections.

What increases my child's risk for bronchiectasis? Your child's risk of having bronchiectasis may increase with any of the following:

Chemical damage: Breathing in harmful fumes may cause swelling and damage to your child's airways. Acid reflux (GERD) from his stomach may also cause damage to your child's airways.
Immune system problems: The immune system is your child's defense against certain diseases and infections. When his defense system is weak, his risk of getting lung infections increases. When his immune system is over-active, it can attack his lung tissues and cause inflammation. This can happen if your child has allergies, rheumatoid arthritis (RA), or a connective tissue disorder.
Inherited diseases: Your child may have been born with genes that cause certain lung problems. A gene is a little piece of information which tells your child's body what to do or make. Genes are passed on by a parent to a child. Cystic fibrosis (CF) is a disease that often causes bronchiectasis in children. Ask your child's caregiver for more information about cystic fibrosis.
Obstruction: This may happen if your child breathes in small pieces of food while he is eating. These can get stuck in his airways. Tumors (lumps) in his chest may grow over time and block his airway.
Other diseases: Having a disease that causes the ciliated cells not to work well may lead to bronchiectasis. The disease can make it hard for your child to clear mucus out of his airways.
Past lung infections: These may cause lasting damage to your child's airways causing bronchiectasis. These infections include whooping cough, tuberculosis, and pneumonia.

What are the signs and symptoms of bronchiectasis? The symptoms of bronchiectasis depend on how damaged your child's airways are. Your child may have one or more of the following:

Early disease signs and symptoms:
- Body weakness and fatigue (sleepiness).
- Frequent, ongoing cough that may or may not bring up phlegm.
- Runny nose and sinus drainage.
- Shortness of breath or wheezing (high-pitched breath sounds).
- Weight loss.
Late disease signs and symptoms:
- Chest pains.
- Clubbing of his fingers or toes. Clubbing is when the ends of your child's fingers or toes become round and thick. This may happen when his body does not get enough oxygen over a long period of time.
- Coughing more than usual with large amounts of phlegm.
- Coughing up blood or phlegm that contains blood.
- Coughing up dark or foul-smelling phlegm.
- Loss of appetite and feeling ill.
- Trouble breathing with activity.

How is bronchiectasis diagnosed? Your child's caregiver will ask about your child's symptoms and his medical history. Your child's caregiver will do a physical exam and he may also order any of the following tests:

Chest x-ray: This is a picture of your child's lungs and heart. Caregivers use it to see how your child's lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection (such as pneumonia) or other problems.
Fiber optic bronchoscopy: A bronchoscopy test may be done to look inside your child's airways and lungs. His caregiver will use a bronchoscope to do this test. A bronchoscope is a long tube with a light and magnifying glass on the end. Your child's caregiver may give him medicine for pain or to help him relax during the test. The scope will be put in your child's mouth and down into his lungs. Caregivers may also do a bronchoalveolar lavage (BAL) through the scope. This is when fluid and cells are sucked up from your child's lungs and tested in a lab. Ask your child's caregiver for more information about this test.
High resolution computed tomography scan: This test is also called a CT scan or HRCT scan. A special x-ray machine uses a computer to take pictures of your child's chest and airways. It may also be used to look at other body organs such as bones, tissues, or blood vessels. Your child may be given dye before the pictures are taken. The dye helps your child's caregiver see the pictures better. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your child's caregiver if he is allergic to shellfish or has other allergies.
Sputum sample: Your child's sputum (mucus) is collected in a special cup and sent to a lab for tests. The sputum may show what germ is causing your child's illness. It may also help your child's caregiver choose what medicine is best for him.
Sweat test: This test is done to see if your child has cystic fibrosis. Ask your caregiver for more information about this test.

How is bronchiectasis treated? Treatment is done to improve your child's symptoms and prevent infections and more airway damage. Your child may be given any of the following treatments:

Medicines:
- Antibiotics: Antibiotics may be given to help your child fight an infection caused by a germ called bacteria.
- Anti-inflammatory medicines: These are also known as non-steroidal anti-inflammatory drugs or NSAIDs. They may help decrease pain and inflammation (swelling). This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before giving your child this medicine.
- Bronchodilators: Bronchodilators may be given to help open the air passages in your child's lungs to help him breathe easier.
- Expectorants: These medicines will help thin your child's sputum (mucus from the lungs). When sputum is thin, it may be easier for him to cough it up and spit it out. This may help your child breathe easier, and may help him get better faster.
- Immune globulins: This may be given to help your child's immune system fight infection. Ask your caregiver for more information about how immune globulin medicine may help your child.
- Steroids: Steroid medicine may help to open your child's air passages so he can breathe easier.
Oxygen: If your child's lungs are damaged, he may need extra oxygen to help him breathe easier. Oxygen may be given through a plastic mask over your child's mouth and nose. It may also be given through a nasal cannula, or prongs. A nasal cannula is a pair of short, thin tubes that rest inside your child's nose. Tell your child's caregiver if his nose gets dry, or if the mask or prongs bother him.
Surgery: This is done to remove the damaged part of your child's lung that is causing his symptoms. Surgery is normally only done if treatment with medicines has failed. Ask your caregiver for more information about this treatment.

What airway clearance techniques can I use to help my child breathe easier? Airway clearance techniques (ACTs) can be used to help loosen mucus in your child's airways. Once the mucus is loose, he will be able to cough it up and out, and he may breathe better. Your child may need to use special devices to help with his ACTs. Doing these therapies on a set schedule may help decrease your child's symptoms quicker.

Airway oscillation: This is a device that works by vibrating your child's airways as he breathes out through it. Your child will need to breathe in and fill his lungs, and hold his breath for 2 to 3 seconds. He then puts the device tightly to his mouth and breathes out normally through it.
Chest wall oscillation: This therapy uses a special vest that your child can wear. It is attached to a machine that causes the vest to vibrate your child's chest.
Percussion: You will need to forcefully pat on your child's back with a cupped hand or soft plastic cup. This is done to loosen mucus that is stuck in his airways. Ask your child's caregiver to show you how to do percussion on your child.
Positive expiratory pressure therapy: PEP therapy uses a device that keeps some air in your child's airways when he breathes out. This helps him prevent trapping mucus in his small airways so he can more easily cough it up.
Postural drainage: This therapy is designed to help drain mucus from different areas of your child's lung. Your child's caregiver will show you to help position your child for this therapy.

What can I do to prevent my child's bronchiectasis from getting worse?

Do not let anyone smoke around your child. Smoking can harm your child's heart, lungs, and blood. If you smoke around your child, he is more likely to get certain types of infections. He is also more likely to get lung disease and cancer later in his life. If you smoke, you should quit. You will not only help yourself, but also those around you. If you are having trouble quitting, talk to your caregiver about ways to quit.
Keep your child away from people who have colds and the flu. Also try to keep your child away from large groups of people if he is recovering from surgery. This decreases your child's chance of getting sick or getting an infection.
Vaccinate your child against the flu and pneumonia. Ask your child's caregiver if he should get a vaccine shot against the flu or pneumonia. The best time to get a flu shot is in October or November. Flu shots are good for one year. Pneumonia shots are good for 5 to 6 years. Ask your caregiver which vaccinations are right for your child.

When should I call my child's caregiver? Call your child's caregiver if:

Your child has a fever.
Your child is coughing more than usual, or has wheezes (high-pitched sound) while breathing.
Your child's medicines do not relieve his symptoms.
You or your child have questions or concerns about his medicine, condition, or care.

When should I seek immediate help? Seek care for your child immediately or call 911 if:

Your child is coughing up blood.
Your child suddenly has trouble breathing.
Your child has trouble thinking, or has fainted.
Your child has very bad chest pain.

Where can I find more information? Having a child with bronchiectasis can be hard for you and your family. You and your child may feel sad or frightened. These feelings are normal. Learning more about bronchiectasis can help you understand how to deal with your child's condition. Contact the following for more information:

American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 1-847-434-4000
Web Address: http://www.aap.org

American Lung Association
61 Broadway, 6th floor
New York City, NY 10006
Phone: 1-800-586-4872
Web Address: http://www.lungusa.org

National Heart, Lung and Blood Institute
Health Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
Phone: 1-301-592-8573
Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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