Is Bronchiectasis An Interstitial Lung Disease?
Bronchiectasis is a disease characterized by dilatation of the airways due to scarring of the lung tissue. It is associated with mucosal thickening and mucus plugging along with a variable degree of over inflation of lung. When mucus clearance and local defense mechanisms are impaired it leads to repeated infections, which further causes damage to the airways. There is increased susceptibility to repeated infections in the lungs that further leads to chronic infections in most of the patients. All these factors lead to decrease in respiratory function.
Bronchiectasis is not an interstitial lung disease, which affects the tissues and spaces around them, called the interstitium. The symptoms also vary in both these diseases. It constitutes a group of lung disorders that affect the interstitium and damage the lung tissue. The disease affects men twice more than women. The patients are usually in the age group of 40 to 70 years of age. The interstitial disease cannot be completely cured, but its progression can be delayed with the use of appropriate treatment. It is usually harder to treat in older patients. Both incidences of interstitial lung disease and mortality due to interstitial lung disease increase as the age progresses. The disease affects the alveoli, airways (trachea, bronchi and bronchioles), interstitium, blood vessels, and pleura (outside lining of the lung). Depending on the type of interstitial lung disease, a person can develop varying degrees of fibrosis, inflammation and different symptoms. Sometimes the damage caused by interstitial lung disease can be permanent and irreversible and does not respond to treatment but only worsens with time.
Symptomatology of Bronchiectasis And Interstitial Lung Disease
A patient of bronchiectasis presents with complaints of chronic productive cough (with sputum that may be either yellow or green), which is frequently seen in patients with early disease. The sputum is associated with a culture of a pathogenic organism. Hemoptysis may be present along with dyspnea or shortness of breath and airflow obstruction.
While a patient with interstitial lung disease presents with symptoms of dyspnea or shortness of breath, dry cough without sputum. In case of prolonged disease swelling of the legs and heart failure might also occur. Other symptoms are wheezing, weight loss, cyanosis (bluish discoloratioin of the skin and mucous membrane due to lack of oxygen in blood) and clubbing of the fingers.
Diagnosis And Management
Interstitial lung disease is diagnosed with the help of pulmonary function tests, high resolution computerized tomography, exercise tests, transbronchial biopsy, bronchioalveolr lavage (fluid sample from the air sacs is taken), chest X ray, video assisted thoracoscopic surgery (to confirm the diagnosis) and blood gases test where the amount of oxygen present in the blood is determined.
Bronchiectasis is diagnosed by high resolution CT and plain chest X ray. Other tests include a blood test and mucus examination.
The best treatment for bronchiectasis is prevention. Early childhood immunization can prevent the development of the disease. In people who have already contracted the disease fighting against the main symptoms of inflammation, infection and mucus buildup is essential. Antibiotics help in fighting against the bacterial infection, while macrolides are used to kill bacteria as well as ease inflammation, which reduce pulmonary exacerbations and improve lung function. To prevent mucus buildup mucus thinners and expectorant can be used. Inhaled beta agonists help in managing airflow obstruction.
Treatment of interstitial lung disease is easier when it is in the early stage. Patients who smoke tobacco should be encouraged to quit if they want better results.
Antifibrotics reduce the development of scar tissue and help slow the progression of the disease. Colchicines and D-penicillamine have shown positive results in most cases. Corticosteroids reduce inflammation in the lungs, but in the long run they cause glaucoma, bone loss, high blood sugar, and poor wound healing and increased susceptibility to infection.
A lung transplant is necessary for patients who have severe interstitial lung disease and who do not respond to other treatment options. In order to receive a transplant a person should be healthy and be willing to follow the medical program. Oxygen therapy makes breathing and exercise easier for interstitial lung disease patients.
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