Bronchiectasis Can Cause Frequent COPD Flare-ups

Bronchiectasis Is Linked to Increased Risk of a COPD Exacerbation

Background: Bronchiectasis is a chronic condition in which the walls of the breathing tubes are thickened from long-term inflammation and scarring. Typically, bronchiectasis is a result of a pneumonia which damages parts of the lung. As a result of the damage, mucus produced by the cells lining the breathing tubes does not drain normally. Mucus build-up can lead to a chronic infection. A cycle of inflammation and infection can develop, leading to loss of lung function over time.

CT scan shows cystic bronchiectasis

A slice of the chest on a high-resolution CT scan in a 62 year old with cystic bronchiectasis. The cysts are seen on the lower portions of both lungs.

Different types of bacteria and mycobacteria can infect the damaged areas of the lung causing:

  1. chronic coughing
  2. coughing up blood
  3. shortness of breath
  4. chest pain
  5. coughing up large amounts of mucus daily
  6. weight loss
  7. fatigue
  8. thickening of the skin under the finger nails and toes (called clubbing)

Poster Presention at CHEST meeting October 25, 2016, in Los Angeles: Dr. Kosmas of the Metropolitan Hospital in Piraeus, Greece, presented findings in 855 individuals with COPD 

42% of the patients were found to have evidence of bronchiectasis on CT scan of the chest. About 20% had experienced more than one flare-up (exacerbation) of COPD in previous year. The investigators also found that the severity of COPD predicted the increased likelihood that a person would have bronchiectasis.

Dr. Kosmas commented at the poster presentation that, “Bronchiectasis is an area in the lung that is destroyed by pneumonia, and bacteria reside there. It results in a low-grade infection, and can then lead to inflammation and an exacerbation.”

My Comments: The symptoms of bronchiectasis usually start off as mild with a persistent cough that produces yellow or green mucus. An antibiotic may help to clear up the mucus, but typically the yellow or green color returns after a few weeks.

A CT scan of the chest is important to diagnose this condition. Then, a fresh sample of the mucus should be obtained to send to the laboratory to identify the specific type of infection (sputum culture). Different blood tests should also be ordered to look for possible medical conditions that may contribute to bronchiectasis (for example, cystic fibrosis, immunodeficiency, HIV infection, alpha-1 antitrypsin deficiency, rheumatoid arthritis, and inflammatory bowed disease).

If you experience frequent chest infections, or continue to cough up yellow-green mucus persistently, ask you health care provider to consider bronchiectasis.

Stopping Smoking – Will My COPD Go from Moderate to Mild?

Stopping Smoking Will Reduce Inflammation

Dear Dr. Mahler:
Is it possible after stopping smoking and following doctors orders to go from moderate to mild copd in a year? Is it detrimental to a copd patient to live in a basement apartment- 5 steps down? The  furnace is not in the apartment. 
Ken from Richmond, VA 
 Dear Ken:
 Yes, if you stop smoking, the inflammation in your breathing tubes (airways) will be reduced and your lung function (results of breathing tests) will improve. How much is hard to say. Also, it is likely that your breathing tubes will produce less mucus because the irritation from smoking cigarettes will have stopped.
Reminder for Stopping Smoking

Reminder for Stopping Smoking

The categories of mild (FEV1 > 80% predicted) and moderate (FEV1 50 – 80% predicted) COPD are based on specific values on breathing tests.  If you have stopped smoking, I congratulate you and encourage you not to smoke again.  If you are still smoking, it is important that you stop completely to prevent worsening (progression) of your COPD.
I am not aware that living in a basement apartment is bad for your breathing. Certainly, you want to breathe as much fresh air as possible.
Donald A. Mahler, M.D.