Editing Bronchiectasis (section)

{{short description|Permanent enlargement of the lung airways}}
{{Infobox medical condition (new)
| name          = Bronchiectasis
| synonyms      =
| image         = Bronchiectasis NHLBI.jpg
| alt           =
| caption       = Figure A shows a cross-section of the lungs with normal airways and widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.
| pronounce     = {{IPAc-en|ˌ|b|r|ɒ|ŋ|k|ɪ|ˈ|ɛ|k|t|ə|s|ɪ|s}}<ref>{{Cite web|url=https://www.lexico.com/en/definition/bronchiectasis|archive-url=https://web.archive.org/web/20191109175656/https://www.lexico.com/en/definition/bronchiectasis|url-status=dead|archive-date=November 9, 2019|title=Bronchiectasis &#124; Definition of Bronchiectasis by Lexico|website=Lexico Dictionaries &#124; English}}</ref>
| field         = [[Pulmonology]]
| symptoms      = Productive cough, [[shortness of breath]], chest pain<ref name=NIH2014Sign/><ref name=Mc2013/>
| onset         = Gradual<ref>{{cite journal|last1=Maguire|first1=G|title=Bronchiectasis – a guide for primary care.|journal=Australian Family Physician|date=November 2012|volume=41|issue=11|pages=842–50|pmid=23145413}}</ref>
| duration      = Long term<ref name=NIH2014What/>
| causes        = Infections, [[cystic fibrosis]], other genetic conditions, [[idiopathic]]<ref name=Mc2013/><ref name=Stat2019>{{cite journal |last1=Bird |first1=K |last2=Memon |first2=J |title=Bronchiectasis |date=January 2019 |journal=StatPearls [Internet] |pmid=28613561 |id=NBK430810 }}</ref>
| risks         =
| diagnosis     = Based on symptoms, [[CT scan]]<ref name=BTS2012/>
| differential  = [[Chronic obstructive pulmonary disease]], [[Asbestosis]], [[Tracheobronchomalacia]]
| treatment     = [[Antibiotic]]s, [[bronchodilator]]s, [[lung transplant]]<ref name=Mc2013/><ref name=NIH2014Tx/><ref name=Cor2013/>
| medication    =
| frequency     = 1–250 per 250,000 adults<ref name=Cot2015/>
| deaths        =
}}
<!-- Definition and symptoms -->
'''Bronchiectasis''' is a disease in which there is permanent enlargement of parts of the [[bronchi|airways]] of the [[lung]].<ref name=NIH2014What>{{cite web|title=What Is Bronchiectasis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/brn|website=NHLBI|access-date=10 August 2016|date=June 2, 2014|url-status=live|archive-url=https://web.archive.org/web/20160810235340/http://www.nhlbi.nih.gov/health/health-topics/topics/brn/|archive-date=10 August 2016}}</ref> Symptoms typically include a chronic cough with [[sputum|mucus]] production.<ref name=Mc2013>{{cite journal|last1=McShane|first1=PJ|last2=Naureckas|first2=ET|last3=Tino|first3=G|last4=Strek|first4=ME|title=Non-cystic fibrosis bronchiectasis.|journal=American Journal of Respiratory and Critical Care Medicine|date=Sep 15, 2013|volume=188|issue=6|pages=647–56|pmid=23898922|doi=10.1164/rccm.201303-0411CI}}</ref> Other symptoms include [[shortness of breath]], [[hemoptysis|coughing up blood]], and chest pain.<ref name=NIH2014Sign>{{cite web|title=What Are the Signs and Symptoms of Bronchiectasis?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/brn/signs|website=NHLBI|access-date=10 August 2016|date=June 2, 2014|url-status=live|archive-url=https://web.archive.org/web/20160823030732/https://www.nhlbi.nih.gov/health/health-topics/topics/brn/signs|archive-date=23 August 2016}}</ref> Wheezing and [[nail clubbing]] may also occur.<ref name=NIH2014Sign/> Those with the disease often get [[lung infection]]s.<ref name=NIH2014Tx>{{cite web|title=How Is Bronchiectasis Treated?|url=https://www.nhlbi.nih.gov/health/health-topics/topics/brn/treatment|website=NHLBI|access-date=10 August 2016|date=June 2, 2014|url-status=live|archive-url=https://web.archive.org/web/20160728042454/http://www.nhlbi.nih.gov/health/health-topics/topics/brn/treatment|archive-date=28 July 2016}}</ref>

<!-- Cause and Diagnosis -->
Bronchiectasis may result from a number of [[infection|infectious]] and acquired causes, including [[measles]],<ref>{{cite news|work = Sydney Morning Herald|access-date=9 August 2022|title=Durham's voice stays pure despite the blows|date=22 April 2010|url=https://www.smh.com.au/national/durhams-voice-stays-pure-despite-the-blows-20100421-szzp.html|archive-url=https://web.archive.org/web/20220809145953/https://www.smh.com.au/national/durhams-voice-stays-pure-despite-the-blows-20100421-szzp.html|archive-date=9 August 2022}}</ref> [[pneumonia]], [[tuberculosis]], [[immune system]] problems, as well as the genetic disorder [[cystic fibrosis]].<ref>{{Cite journal|last1=José|first1=R. J.|last2=Brown|first2=J. S.|date=2014|title=Bronchiectasis|journal= British Journal of Hospital Medicine|volume=75|issue=Suppl 10:C146–51|pages=C146–C151|doi=10.12968/hmed.2014.75.Sup10.C146|pmid=25289486}}</ref><ref name=Mc2013/><ref name=DAVIDSONS2010>{{cite book |editor1=Nicki R. Colledge |editor2=Brian R. Walker |editor3=Stuart H. Ralston |others=illustrated by Robert Britton |title=Davidson's principles and practice of medicine. |year=2010 |publisher=Churchill Livingstone/Elsevier |location=Edinburgh |isbn=978-0-7020-3085-7 |edition=21st}}</ref> Cystic fibrosis eventually results in severe bronchiectasis in nearly all cases.<ref>{{cite book|editor-last1=Brant|editor-first1=William E.|editor-last2=Helms|editor-first2=Clyde A.|title=Fundamentals of diagnostic radiology|date=2006|publisher=Lippincott Williams & Wilkins|location=Philadelphia|isbn=9780781761352|page=518|edition=3rd|url=https://books.google.com/books?id=Sossht2t5XwC&pg=PA518|url-status=live|archive-url=https://web.archive.org/web/20170906121052/https://books.google.com/books?id=Sossht2t5XwC&pg=PA518|archive-date=2017-09-06}}</ref> The cause in 10–50% of those without cystic fibrosis is unknown.<ref name=Mc2013/> The mechanism of disease is breakdown of the airways due to an excessive inflammatory response.<ref name=Mc2013/> Involved airways ([[bronchi]]) become enlarged and thus less able to clear secretions.<ref name=Mc2013/> These secretions increase the amount of [[bacteria]] in the lungs, resulting in airway blockage and further breakdown of the airways.<ref name=Mc2013/> It is classified as an [[obstructive lung disease]], along with [[chronic obstructive pulmonary disease]] and [[asthma]].<ref>{{cite book|author=Michael Filbin|author2=Lisa M. Lee|first3=Brian L.|last3=Shaffer|title=Blueprints pathophysiology II : pulmonary, gastrointestinal, and rheumatology : notes & cases|date=2003|publisher=Blackwell Pub.|location=Malden, Mass.|isbn=9781405103510|page=12|edition=1st|url=https://books.google.com/books?id=9QuInLjbHn0C&pg=PA12|url-status=live|archive-url=https://web.archive.org/web/20170906121052/https://books.google.com/books?id=9QuInLjbHn0C&pg=PA12|archive-date=2017-09-06}}</ref> The diagnosis is suspected based on symptoms and confirmed using [[computed tomography]].<ref name=BTS2012>{{cite web|title=Quality Standards for Clinically Significant Bronchiectasis in Adults|url=https://www.brit-thoracic.org.uk/standards-of-care/quality-standards/bts-bronchiectasis-quality-standards/|publisher=British Thoracic Society|access-date=29 April 2017|date=July 2012|url-status=dead|archive-url=https://web.archive.org/web/20170707001137/https://www.brit-thoracic.org.uk/standards-of-care/quality-standards/bts-bronchiectasis-quality-standards/|archive-date=7 July 2017}}</ref> [[Sputum culture|Cultures of the mucus]] produced may be useful to determine treatment in those who have acute worsening and at least once a year.<ref name=BTS2012/>

<!-- Treatment and Prognosis-->
Periods of worsening may occur due to infection.<ref name=NIH2014Tx/> In these cases, [[antibiotics]] are recommended.<ref name=NIH2014Tx/> Common antibiotics used include [[amoxicillin]], [[erythromycin]], or [[doxycycline]].<ref>{{cite book|last1=Brent|first1=Andrew|last2=Davidson|first2=Robert|last3=Seale|first3=Anna|title=Oxford Handbook of Tropical Medicine|date=2014|publisher=OUP Oxford|isbn=9780191503078|page=223|url=https://books.google.com/books?id=jFpuAwAAQBAJ&pg=PA223|url-status=live|archive-url=https://web.archive.org/web/20160821102652/https://books.google.ca/books?id=jFpuAwAAQBAJ&pg=PA223|archive-date=2016-08-21}}</ref> Antibiotics, such as erythromycin, may also be used to prevent worsening of disease.<ref name=Mc2013/><ref name=Qi2014>{{Cite journal|last1=Wu|first1=Qibiao|last2=Shen|first2=Weixing|last3=Cheng|first3=Haibo|last4=Zhou|first4=Xiqiao|date=April 2014|title=Long-term macrolides for non-cystic fibrosis bronchiectasis: a systematic review and meta-analysis|journal=Respirology|volume=19|issue=3|pages=321–9|doi=10.1111/resp.12233 |pmid=24417869|s2cid=2567740|doi-access=free}}</ref> [[#Airway clearance|Airway clearance]] techniques, a type of [[physical therapy]], are also recommended.<ref name=Lee2015>{{cite journal|last1=Lee|first1=AL|last2=Burge|first2=AT|last3=Holland|first3=AE|title=Airway clearance techniques for bronchiectasis.|journal=The Cochrane Database of Systematic Reviews|date=23 November 2015|volume=2015 |issue=11|pages=CD008351|pmid=26591003|doi=10.1002/14651858.CD008351.pub3|pmc=7175838}}</ref> [[Bronchodilator|Medications to dilate the airway]]s and inhaled [[Corticosteroid|steroids]] may be used during sudden worsening, but there are no studies to determine effectiveness.<ref name=Mc2013/><ref name=":3">{{Cite journal|last1=Kapur|first1=Nitin|last2=Petsky|first2=Helen L.|last3=Bell|first3=Scott|last4=Kolbe|first4=John|last5=Chang|first5=Anne B.|date=16 May 2018|title=Inhaled corticosteroids for bronchiectasis|journal=The Cochrane Database of Systematic Reviews|volume=2018|issue=5|pages=CD000996|doi=10.1002/14651858.CD000996.pub3 |pmc=6494510|pmid=29766487}}</ref> There are also no studies on the use of inhaled [[Corticosteroid|steroids]] in children.<ref name=":3" /> Surgery, while commonly done, has not been well studied.<ref>{{cite journal|last1=Corless|first1=JA|last2=Warburton|first2=CJ|s2cid=72965871|title=Surgery vs non-surgical treatment for bronchiectasis.|journal=The Cochrane Database of Systematic Reviews|date=2000|volume=2000 |issue=4|pages=CD002180|doi=10.1002/14651858.CD002180|pmid=11034745|pmc=8407459}}</ref><ref name=Mc2013/> [[Lung transplantation]] may be an option in those with very severe disease.<ref name=Cor2013>{{cite journal|last1=Corris|first1=PA|title=Lung transplantation for cystic fibrosis and bronchiectasis.|journal=Seminars in Respiratory and Critical Care Medicine|date=Jun 2013|volume=34|issue=3|pages=297–304|pmid=23821505|doi=10.1055/s-0033-1348469|s2cid=32614762 }}</ref>

<!-- Epidemiology and History -->
The disease affects between 1 per 1000 and 1 per 250,000 adults.<ref name=Cot2015>{{cite book|last1=Cottin|first1=Vincent|last2=Cordier|first2=Jean-Francois|last3=Richeldi|first3=Luca|title=Orphan Lung Diseases: A Clinical Guide to Rare Lung Disease|date=2015|publisher=Springer|isbn=9781447124016|page=30|url=https://books.google.com/books?id=U-InBgAAQBAJ&pg=PA30|url-status=live|archive-url=https://web.archive.org/web/20160821104334/https://books.google.ca/books?id=U-InBgAAQBAJ&pg=PA30|archive-date=2016-08-21}}</ref> The disease is more common in women and increases as people age.<ref name=Mc2013/> It became less common since the 1950s with the introduction of antibiotics.<ref name=Cot2015/> It is more common among certain ethnic groups (such as [[indigenous people]] in the US).<ref name=Cot2015/> It was first described by [[René Laennec]] in 1819.<ref name=Mc2013/> The economic costs in the United States are estimated at $630 million per year.<ref name=Mc2013/>