Bronchiectasis

WHAT YOU SHOULD KNOW:

• Bronchiectasis (bron-key-ECK-tah-sis) is a lung condition where your bronchi get too wide and mucus build up in them. Your bronchi are medium-sized airways (tubes that carry air in and out of your lungs). With bronchiectasis, your lung airways get damaged and cannot clear out the mucus the way they should. The mucus stays in the airways and germs grow in it, causing new and repeated lung infections. Over time, this can cause your airways to swell and to become stretched out and scarred. As your airways become damaged, it gets harder for you to move air through them when you breathe. This is permanent damage that may happen only in one part of your lungs or in many places in your lungs.
  
  
• Bronchiectasis is caused by having repeated infections and inflammation (swelling) in your lungs. Inflammation can be caused by diseases that affect the lungs, past lung infections, and immune system problems. Other causes include things that irritate or block your airways, but the exact cause may be unknown. You may have an ongoing cough, trouble breathing, or cough up large amounts of phlegm (lung mucus). You may feel tired and weak, wheeze when you breathe, and have sinus or nasal drainage and chest pain. A chest x-ray, computed tomography (CT) scan, and sputum samples can help caregivers learn more about your condition. Treatment includes medicines, airway clearance techniques (ACTs), and oxygen. You may also need surgery if other treatments do not work. Early treatment may help relieve your symptoms and prevent further damage to your airways.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

Medicines used to treat bronchiectasis may make you dizzy, and increase your heart rate. They may cause you to gain weight and have skin problems. You may also be at a higher risk of getting mouth infections and a sore throat. You may bleed more than usual or get an infection after lung surgery. If bronchiectasis is untreated, your airways may thicken and become filled with mucus, letting less air pass through them. As more airway damage happens you may get lung conditions such as emphysema (air trapped in tiny sacs). Pressure can grow in your pulmonary artery (blood vessel) that leads to right-sided heart failure. You can have chronic (long-lasting or repeated) respiratory failure, or life-threatening lung bleeding. Ask your caregiver if you have questions about your condition, medicines, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Blood tests:

You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Vital signs:

Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Medicines:

You may be given the following medicines:

• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Anti-inflammatory drugs: This family of medicine is also known as non-steroidal anti-inflammatory drugs or NSAIDs. They may help decrease pain and inflammation (swelling). NSAIDs may also be given to decrease a high body temperature (fever).
  
  
• Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
  
  
• Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs). When sputum is thin, it may be easier for you to cough it up and spit it out. This may make your breathing easier, and may help you get better faster.
  
  
• Immune globulins: This medicine is given as a shot or an IV infusion to make your immune system stronger. You may need immune globulins to treat or prevent an infection. It is also used when you have a chronic condition, such as lupus or arthritis. You may need many weeks of treatment. Each infusion can take from 2 to 5 hours.
  
  
• Steroids: Steroid medicine may help to open your air passages so you can breathe easier. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.

Tests:

• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• 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 chest and airways. It may also be used to look at other body parts such as bones, tissues, or blood vessels.
  
  
• Pulmonary function tests: Pulmonary function tests (PFTs) help caregivers learn how well your body uses oxygen. You breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. PFTs help your caregivers decide the best treatment for you.
  
  
• Sputum sample: Sputum (mucus from your lungs) is collected in a cup when you cough. The sample is sent to a lab to be tested for the germ that is causing your illness. It can also help your caregiver choose the best medicine to treat the infection.

Treatment options:

Caregivers may teach you ways to help loosen mucus in your airways so you can more easily cough it up. There are many different types of airway clearance techniques (ACTs) that you can use. Ask your caregiver to help you decide on the ACT program that is best for you, and how often you need to do it. Doing ACT's regularly over time can help decrease your symptoms.

• Breathing techniques:
  
  
  • Controlled breathing: Controlled breathing is when you practice breathing gently, slowly, and deeply. You may also need to breathe out air as fast as you can, which will help force mucus out of your airways.
    
    
  • Chest expansion exercises: Chest exercises help you completely fill your lungs with air by letting your abdomen swell as you breathe in.
    
    
  • Forced expiration technique: Coughing is a forceful response to something irritating your airway. Huffing is less forceful and tiring, and can be done instead of coughing. It is a controlled, less forceful pushing out of breath with your diaphragm and chest muscles. The diaphragm is the large muscle at the bottom of your chest that helps you breathe.
  
  
  
  • Lung drainage: This is a method that can be used to bring up mucus from lower parts of your airways or lungs. In this exercise you sit up straight and slowly breathe in through your nose to fill your lungs. You then hold your breath for 3 to 4 seconds, and breathe out as fast as you can through your nose. You may need to repeat this exercise several times to push out the mucus.
    
    
  • Chest physical therapy:
    
    
    • Percussion: This involves having another person forcefully pat on your back with a cupped hand or soft plastic cup. It is done to loosen mucus stuck in your airways. Percussion may also be done with an electric percussor.
      
      
    • Postural drainage: This therapy is designed to help drain mucus from different parts of your lung. Your caregiver will show you the body positions to be in for this therapy.
  
  

• ACT with equipment:
  
  
  • High frequency chest wall oscillation: This therapy uses a special vest that you wear. It attaches to a machine that causes the vest to vibrate your chest.
    
    
  • Oscillating positive end pressure therapy: This method uses a small, pocket-sized device that works by vibrating your airways as you breathe out through it. You will need to breathe in and fill your lungs, and hold your breath for 2 to 3 seconds. You then put the device tightly to your mouth and breathe out normally through it.
    
    
  • Positive expiratory pressure therapy: PEP therapy uses a device that keeps some air in your airways when you breathe out. This helps prevent mucus from getting trapped in your small airways, making it easier to cough up.
  
  

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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.

Learn more about Bronchiectasis (Inpatient Care)