The Vicious Cycle of Bronchiectasis
When a patient is diagnosed with bronchiectasis, a plan for long-term monitoring and care is critical. Some patients experience daily and burdensome symptoms that worsen upon exacerbation.
Bronchiectasis moves in a cycle with the potential to cause increasing amounts of damage to airways. Untreated, this vicious cycle of infection, inflammation, and injury often results in progressive symptoms and loss of lung function, decreased activity and quality of life, chronic lung infection, and poor pulmonary function tests.
Because bronchiectasis is frequently secondary to these other conditions, it can be difficult to diagnose and to determine the proper course of treatment. Both doctors and patients must learn to recognize the cycle associated with bronchiectasis so that symptoms may be addressed and additional damage prevented.
Understanding the Cycle
Bronchiectasis progresses according to a cycle first proposed by P. J. Cole and known as Cole’s theory. The cycle follows a distinct pattern recognizable by characteristics associated with each phase:
This cycle continues to repeat itself and compound the damage to lung tissue unless symptoms are properly diagnosed and addressed with a comprehensive treatment plan including bronchial hygiene techniques such as Airway Clearance Therapy. Since bronchiectasis is often associated with conditions like COPD and cystic fibrosis, testing patients with these diseases for lung problems should be a top priority for physicians.
The Problem of Recurring Lung Infections
Recurring infections may be caused by different pathogens or may be chronic due to mucus failing to be cleared from the lungs. Patients with bronchiectasis have been shown to harbor more bacteria and other pathogens in the lungs and have more inflammatory markers in their bodies. Exacerbations are made worse by and can be more frequent during infections, a complication indicative of increased inflammation and progressive tissue damage.
Once bronchiectasis has been triggered, it becomes difficult for sufferers to avoid subsequent infections. Any bacterial or viral lung infection can cause more inflammation, leading to more damage and making bronchiectasis increasingly harder to treat. Infections are also responsible for causing exacerbations, acute periods during which symptoms become more severe and can have a serious impact on a patient’s quality of life.
Chronic Inflammation puts patients with bronchiectasis at higher risk for:
Any occurrence of these infections perpetuates the inflammatory cycle, causing additional lung damage. The potential for progressive deterioration makes monitoring for infections and administering prompt treatment all the more important.
Avoiding Failed Treatments
In the majority of patients with bronchiectasis, there are strategies for preventing or slowing its progression. The two most important elements of these strategies are clearance of airway secretions with Airway Clearance Therapy and prompt treatment of lung infections with antibiotics.
Failing to treat bronchiectasis properly can result in increased lung damage and greater difficulty breathing. It’s often necessary to combine treatment types when seeking to fully manage symptoms and prevent worsening of symptoms.
Airway Clearance Therapy
Airway clearance is critical to management of bronchiectasis. Keeping airways clear of secretions helps breaks the cycle of infection and inflammation. Chest physiotherapy (CPT) is often the first airway clearance technique suggested to help loosen and raise mucus. Vibration and percussion from CPT will “shake loose” thick mucus allowing the patient to cough it up and clear their airways. Mechanical HFCWO vests deliver vibrations to the chest, mimiking hand CPT, to loosen and mobilize secretions.
Another important considerations is matching antibiotic treatments to the types of infections present, ensuring the body can clear it before additional damage is done. Supporting antibiotic treatments with inhaled steroids may prove to be effective. Administering these drugs along with bronchodilators can help some patients loosen thick mucus. Antibiotics delivered via inhalers can also be useful depending on the type and severity of an infection.
Learn more about Bronchiectasis
Find out more about the signs and symptoms with the AffloVest Bronchiectasis Resource Kit
Minimizing the Impact of Bronchiectasis
A comprehensive treatment plan to address the infections and inflammation associated with bronchiectasis should incorporate lifestyle changes aimed at strengthening immunity and keeping the whole body healthy. Such changes include:
Quitting smoking and avoiding secondhand smoke
Minimizing use of and exposure to toxic chemicals
Eating a healthy diet of whole, unprocessed foods
Maintaining an appropriate weight
Getting adequate rest and sleep
Positive lifestyle changes may reduce the chances of failed bronchiectasis treatments and can help prevent the decline associated with the cycle of the disease.
Having a plan to manage secerity of bronchiectasis, including effective methods for clearing mucus, lowers the risk of recurring infections.
It’s important for patients to clearly communicate any changes in symptoms, including the level of severity, and for doctors to respond by ordering new tests or making appropriate adjustments to medications. New or more severe infections require different antibiotics, and hospitalization is sometimes necessary for the administration of IV medications. Some bronchiectasis patients require long-term antibiotic treatment to keep infections at bay.
Patients and doctors can work together to identify and control triggers, address infections and develop a lifestyle plan to reduce the impact of this chronic lung disease. With the right course of treatment and ongoing monitoring, the airway damage characteristic of bronchiectasis can be minimized.