Bronchiectasis

Bronchiectasis is a destructive lung disease characterised by chronic dilatation of the bronchi associated with persistent though variable inflammatory process in the lungs. These changes may involve any area but are predominantly found in the lung bases and can be divided into localized and diffuse forms.
Causes:
1. Host defence defects:
(a) Immune defects:Immunoglobulin deficiency (lgG2 and lgG4), complement deficiency, phagocyte defects.
(b) Chronic granulomatous disease.
(c) Chediak-Higashi syndrome.
(d) Leucocyte adherence deficiency.
(e) Hyperimmune states: Allergic bronchopulmonary aspergillosis, post-lung transplantation.
(f) Mucociliary clearance defects: Immotile cilia, Kartegener??s syndrome (situs inversus, sinusitis and bronchiectasis);Chandra-Khetarpal syndrome; Young??s syndrome, cystic fibrosis.
2. Localised bronchial obstruction: Inhalation of foreign body, benign tumor, external compression (e.g. nodes of primary tuberculosis).
3. Following infections: T.B., measles pneumonia, whooping cough, adenoviruses, mycoplasma pneumonia, pneumococcal pneumonia, AIDS.
4. Lung inflammation: Gastric aspiration, toxic gas inhalation (e.g. ammonia), 4 heroin, inflammatory bowel disease, rheumatoid arthritis, systemic vasculitis.
5. Others: Diffuse pulmonary fibrosis, absence of bronchial cartilage, yellow nail syndrome, primary lymphoedema, treated lymphoreticular malignancy, a-antitrypsin deficiency (rare).
Symptoms??Clinical types:
1. Bronchitic??Attacks of recurrent bronchitis, more common in winter. Clubbing of fingers diagnostic.
2. Haemorrhagic (bronchiectasis sicca)??Recurrent haemoptysis with good health in between, or attacks of bronchitis.
3. Suppurative-- Chronic cough, copious purulent expectoration, general toxemia, clubbing of fingers varying from slight parrot beak curvature of finger nails to bulbous drum stick enlargement (pulmonary osteoarthropathy), dyspnoea and perhaps haemoptysis, weakness, loss of appetite, digestive disturbances, loss of weight, mild anaemia. The paranasal sinuses are frequently infected. Retardation of growth may occur in children.
4. With relatively rapid onset??Symptoms developing with comparative suddenness, as a sequel to partial bronchial obstruction by a foreign body or after anaesthesia. In early stages paroxysmal cough with occasional offensive sputum which may be provoked by change of position. Later large amounts of foetid sputum.
In traditional Chinese medical studies, clinically, it belongs to the category of ke sou (cough), tan chui (stimulate production of sputum/phlegm) and ke xue (coughing out of blood or hemoptysis). Our motherland medical studies consider that the lungs are fragile organs which cannot endure excessive temperature changes; if the lungs are affected by excessive of heat, it will cause disturbances in blood circulation, disorganization of lung tissues and blood, thus easily causing pus (purulent) and the non-smoothness of gases ventilation, disturbances in inspiration and expiration, hence resulted in cough, repeated hemoptysis, spitting big volume of purulent phlegm with fishiness smell; excessive of heat, imbalance between evil (abnormality) and good (body system), thus forcing discharge of fluid and resulted in warm sweat; insufficiency of Yang Qi (Yang energy or gas), accumulation of phlegm in shang jiao (an acupuncture point in lung), thus causing dullness in the chest, dyspnea or chest pain, cyanosis; the spleen regulates the gas and blood system, weakness of spleen will cause imbalance of fluid homeostasis that will resulted in loss of appetite, decreased of mental capacity, body weakness and deformation of finger and toe nails.