BRONCHIECTASIS

an abnormal expansion of the bronchial tubes in the lungs as a result of inflammation and obstruction. Usually the disorder occurs as the result of a preexisting lung disease. Obstruction of the bronchi can result from tumours, mucus plugs, foreign objects (e.g., coins, food, candy), or abscesses. The obstruction, in turn, may lead to accumulation and stagnation of secretions and infections and loss of tone in the bronchial walls. Short-term infections, such as measles, whooping cough, pneumonia, or influenza, cannot by themselves cause bronchiectasis, but they can cause ulcers or weak spots in the bronchial walls. Chronic infections cause continued inflammation of the bronchial walls. The elastic and muscle fibres tend to degenerate in these circumstances, and this degeneration allows the dilatation of the bronchi. Inflammation can also cause a physiological block, in which paralysis of the bronchial walls prevents the removal of secretions from the tubes by peristaltic action. Once dilatation occurs, secretions tend to accumulate, and infection spreads and intensifies. Clinically, the disease is manifested by the presence of infective agents and by an overabundance of mucous secretions. Coughing may produce a thick purulent discharge from the passageways. In severe cases, the sputum discharge may be heavy and may have a strong offensive odour. Generally the infection produces fatigue and growth retardation in children. Breathing may become laboured, and the skin acquires a bluish tint. Complications that can arise from bronchiectasis are recurrent pneumonia, lung abscesses, and bleeding and spitting of blood. Chronic bronchiectasis may cause clubbing of the toes and fingers. The diagnosis is generally made by X-ray examinations. Treatment involves determining which segments of the lungs are afflicted and then draining them two or three times daily. Even after improvement has occurred, drainage is continued for a lengthy period. Antibiotics are administered for a limited time to destroy the infective organisms. If only one lung is diseased, surgical removal of the affected segments can be performed. With control of infection, life expectancy is normal in moderately involved cases.