In the presence of a persistent cough accompanied by phlegm production and frequent episodes of respiratory infections, a hypothesis to be considered
Between chronic respiratory diseases Bronchiectasis, more common than you think, but little known to the general public, can also be dealt with. In presence of some red flags such as cough, phlegm and frequent respiratory infections always perform a check and evaluate the state of the bronchial tree. To put the spotlight on this condition we thought a international group of researcherswith an article recently published in the journal Lancet Respiratory Medicine. Scientists first defined bronchiectasis, with the aim of build a path dedicated to patients with this chronic respiratory disease and at the same time to identify targeted therapies because to date there are no medicines registered at European and American level for this disease.
What is meant by bronchiectasis?
The definition of bronchiectasis concerns two aspects: the high resolution CT scan of the chest of abnormal and permanent dilations of the bronchi and the presence of typical manifestations such as cough, phlegm production and frequent episodes of respiratory infections. To these can be added other symptoms such as the presence of blood in the spit, shortness of breath and generalized fatigue. Due to the abnormal dilation of part of the bronchial tree, the bronchi lose their natural ability to clean the mucusexplains Stefano Aliberti, director of the Pneumology Unit of the Humanitas Clinical Institute in Milan and full professor of respiratory diseases at Humanitas University in Milan, as well as first author of the publication. The result that the latter accumulates within these dilationspromoting the growth of pathogenic microorganisms, such as bacteria, fungi and mycobacteria, which can lead to a vicious cycle of inflammation and infection.
How are bronchiectasis diagnosed?
The diagnosis both radiological and clinical: the lungs are studied with high resolution CT scan of the chest to highlight the abnormal dilations of the bronchi and at the same time the symptoms are evaluated. The first step is to try to identify the genetic or acquired cause of bronchiectasis because, if we can find it, we can act on the natural history of the disease. Unfortunately in about 45% of cases it is not possible to identify the triggering factor. Bronchiectasis are not directly caused by cigarette smoking, but can have genetic (e.g. cystic fibrosis) and non-genetic causes.
In adults, the most common causes are post-infectious ones, followed by primary or secondary immunodeficiencies. Post-infectious bronchiectasis is nothing more than the outcome, the “scar”, of a previous and important lung infection such as pneumonia or tuberculosis. Furthermore, it has been seen that bronchiectasis often occur in individuals suffering from chronic inflammatory bowel and autoimmune diseases, Professor Aliberti reports. A fundamental aspect to investigate concerns the identification of germs that lodge in bronchiectasis to be able to undertake specific antimicrobial interventions and break the vicious circle of infection and inflammation. Other aspects to be evaluated are then respiratory function with global spirometry and the presence of comorbidities such as gastroesophageal reflux, osteoporosis and chronic sinusitis.
How can they be treated?
There are no targeted drugs today, although promising results have recently been presented on an inhaled antibiotic and an anti-inflammatory that could prove to be valuable allies in the near future. In general, we act on several fronts in relation to how the disease manifests itself in the single individual. The most important treatment is respiratory physiotherapy which, thanks to an individualized program of specific exercises, aims to remove the mucus that stagnates in bronchiectasis and to resolve the vicious circle of inflammation and infection. Other weapons include antimicrobial drugs to combat the microorganisms that proliferate in bronchiectasis, anti-inflammatory therapies, bronchodilator drugs in the presence of bronchial obstruction as well as treatments to manage infectious exacerbations and complications such as the presence of blood in the sputum. For optimal management of the disease a multidisciplinary approach is important. The pulmonologist, supported by the respiratory physiotherapist, must be able to count on the collaboration of a clinical microbiologist, immunologist, otolaryngologist, radiologist, geneticist and other specialists to manage the frequent comorbidities.
February 11, 2022 (change February 11, 2022 | 19:42)
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