Bronchiectasis is a debilitating lung condition that can severely affect one’s quality of life, causing recurrent infections, coughing, and shortness of breath. As a Thoracic Surgeon, I have witnessed first-hand the harmful impact this condition can have on a person’s well-being. This chronic ailment causes damage and widening of the airways in the lungs, making it arduous for them to clear secretions and mucus effectively. In this article, we will delve into what bronchiectasis is, its symptoms and causes, and the viable option of surgery for its treatment.
What is Bronchiectasis?
The term Bronchiectasis comes from two Greek words; “Bronkhia” and “Ektasis” meaning “Airway widening”. Bronchiectasis is a perplexing chronic condition that affects the airways in the lungs causing irreversible dilatation of the bronchial tree. It impedes the airways’ ability to clear mucus and other secretions effectively, resulting in build-up of mucus in lungs leading to recurrent lung infections, pneumonias and other complications. Bronchiectasis can be treated by medicines, surgery or a combination of both.
Symptoms of Bronchiectasis
- Coughing that worsens over time, more in the morning time
- Fatigue
- Shortness of breath
- Chest pain or tightness
- Hemoptysis or Coughing up blood
- Recurrent chest infections
- Respiratory failure
- Right heart failure
Causes of Bronchiectasis
Most of the cases of bronchiectasis are idiopathic in etiology
However, it may be found in a variety of pulmonary diseases like:
- Cystic fibrosis (CF)
- Kartagener syndrome (triad of situs inversus, chronic sinusitis, and bronchiectasis)
- COPD
- Alpha 1-antitrypsin deficiency
- Bronchial asthma
- Primary immunodeficiencies
Bronchiectasis treatment options
The treatment of bronchiectasis includes:
- Medications
- Airway clearance techniques
- Pulmonary rehabilitation
- Surgery for bronchiectasis
Medications like antibiotics (Long-term inhaled or oral antibiotic therapy), bronchodilators and anti-inflammatory agents can ease the symptoms and prevent infections.
Airway clearance techniques such as chest physiotherapy and the use of nebulizers can help in clearing mucus and secretions from the airways.
Pulmonary rehabilitation, which involves breathing exercises and physical therapy, can boost lung function and enhance overall quality of life.
Surgery for Bronchiectasis
When is it Recommended?
Surgery for bronchiectasis is usually considered when:
- The condition is severe and affecting daily life
- Medications and other treatments have not been effective
- There is a high risk of complications such as lung abscesses or respiratory failure
As per the British Thoracic Surgery (BTS) guidelines, the indications of surgery for bronchiectasis include:
- Persistent symptoms despite up to a year of comprehensive medical treatment
- Exacerbations that are either severe or frequent and interfere with social/professional life Recurrent refractory or massive hemoptysis
- Post obstruction bronchiectasis distal to tumors
- Localized severely damaged lobe/segment/lung that may be a source of sepsis that left in situ may lead to extension of lung damage
- Treatment of complications such as empyema or lung abscess
Types of surgery for bronchiectasis
The type of surgery for bronchiectasis depends on the severity and location of the damage.
Lung Resections: Surgery for Bronchiectasis
If the diseased area is limited to a lobe, segment or one lung, the options are –
- Anatomical lung resections (Lobectomy, Segmentectomy, Bilobectomy, Pneumonectomy)
- Non-Anatomical lung resections (Wedge resection)
Lung Transplant: Surgery for Bronchiectasis
Double Lung Transplant is an option for End-stage Bronchiectasis, where both lungs are damaged extensively. These patients have no or limited normal lung tissue to carry on the act of breathing and are progressively dependent on supplemental oxygen.
Approach for Surgery for Bronchiectasis
Posterolateral thoracotomy is the standard approach for pulmonary resection in patients with bronchiectasis. Preservation of the integrity of chest wall muscles using muscle-sparing technique is essential to reduce postoperative pain and generate an effective cough. When the decision is for bilateral lung resection, the second operation can be performed with an interval of 1–4 months
Most lung resections for bronchiectasis can now be safely performed using Video-Assisted Thoracic Surgery (VATS), a minimally invasive procedure, in expert hands. During a video-assisted lobectomy, a surgeon makes 1 to 3 small incisions in the chest near the affected lung. A thoracoscope (camera) is inserted in one of the incisions to inspect the entire chest cavity including the lungs. The camera projects an image onto a video screen, helping to guide the surgeon during the procedure. The surgeon inserts surgical instruments through the other incisions in order to remove the lobe.
Recovery After Surgery for Bronchiectasis
After a lobectomy, patient remains in the hospital for several days. The doctor will prescribe pain medications to alleviate any discomfort and give supplemental oxygen until patient is able to breathe on his own.
While in the hospital, pulmonary rehabilitation specialists will teach deep breathing and coughing exercises, which help to reopen airways and strengthen the lungs after surgery.
It is advised to avoid lifting heavy lifting for a few weeks, as well as exposure to smoke and fumes.
Conclusion
Bronchiectasis is a chronic lung condition that can severely impact a person’s quality of life. While there are several treatments available, surgery is becoming an increasingly viable option for those who have exhausted other avenues. Suppose you or someone you know experiences the symptoms of bronchiectasis you can get in touch with Dr. Kamran Ali and his team for management of the same.
