Similarities Between COPD and Bronchiectasis

The Action of Breathing

First a look at the lungs themselves and what happens inside our body when we breathe:

1) Air goes into your nose and down into your windpipe (Trachea) into the lungs

2) Your airway is calledBronchi whichbranch out and down into smaller tubes called Bronchioles

3) At the end of these bronchioles are tiny air sacs called alveoli

4) The purpose your lungs is to providegas exchange ( giving oxygen to your body and taking out carbon dioxide from the blood so you don’t look like a blueberry eating smurf!)

5) There are capillaries in the walls of all these tiny alveoli or ‘air sacs’ that perform this gas exchange.

6) As a result of breathing in and out the air sacs {alveoli} have to remain stretchy, elastic,and free to open and close easily.

7) This is simplified of course but if you think of your Bronchial Tube as the trunk of a tree and their branches spread out and through your lungs then where the ends of the branch occur each tiny branch will result in the air sacs or alveoli

Normal Lungs vs Lungs with COPD
Normal Lungs vs Lungs with COPD | Source

And that is the physiological action that takes place when we breathe in and out. No one really gives it a thought, it is an automatic response to living on this blue ball, our earth.

On the other hand, with COPD, your air sacs are no longer elastic and as the disease progresses the alveoli disappear, are destroyed and the ones left are fewer and become larger than normal simply because they are no longer elastic. Think of a balloon that you blow up and then let all the air out over and over. Eventually the balloon is bigger than it was in the beginning and it takes less effort to blow it up but when you release the trapped air in that stretchy balloon it comes out much faster and the balloon doesn’t fly off across the room as far as it did when it was brand new. That’s just a simple way to think about it.

For persons with COPD, this exchange not easily done nor is it an automatic response, rather, it takes great effort. Persons afflicted with this disease cannot breathe without great effort. The more advanced the disease becomes the more difficult it is to breathe. This disease develops slowly but its course is intractable. Your physician can help you live as well as possible and treatment can slow the progression but there is no cure at this time.

What Are The Causes Of COPD?

Tobacco Smoking, and long term exposure to noxious gases are the two leading causes of COPD.

Of tobacco smokers about 1/4th will develop COPD [http://www.mayoclinic.org/diseases-conditions/copd/basics/causes/con-20032017]

Chronic bronchitis and emphysema are two conditions that are linked to COPD. A person with this condition may have other conditions of impaired breathing.

Chronic bronchitis is inflammation of the bronchial tubes and emphysema is when the alveoli are damaged as far down as the bronchioles

Emphysema is defined as a disease that damages the air sacs (alveoli) of the lungs. Mayo Clinic online states that:

“In emphysema, the inner walls of the air sacs weaken and eventually rupture — creating one larger air space instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.”

Therefore, just as with COPD the alveoli are no longer elastic and stretchy but rather get so weak the air sacs themselves rupture and are not able to replicate or grow new air sacs.

Signs and Symptoms of COPD

Shortness of breath especially with exertion, chronic and highly productive cough especially in the morning and cyanosis or bluish colour to nail beds and lips. Usually a person’s phlegm is white and frothy in colour. A person with COPD may have a torso that looks like Popeye with a thick high or barrel chested look to their upper bodies. People with this condition are prone to respiratory infections especially as they age and they also are at higher risk of aspiration as the disease progresses because when it is difficult to breathe and their coughing increases they may aspirate fluid or food particles into their lungs

How COPD Feels

Take a deep breath in and out three times. On the fourth deep breath in do not let your air out but continue trying to breathe. This will result in you having to take small puffs of air in and a tiny tiny exhalation of air out your nose. Or, it is as if you are trying to breathe with only a small portion of your lungs capacity. This is just the way it feels, not the specific way a person with COPD breathes

How Is COPD Diagnosed?

Mayo Clinic states COPD can be misdiagnosed. Sometimes people who smoke cigarettes are given the diagnosis when it may be a matter of deconditioning or another less common lung disease or condition. On the Mayo Clinic site the definition of COPD is as follows:

“COPD is a lung disease that also includes chronic bronchitis (swelling of the tubes leading to the lungs) and emphysema (damage to the air sacs in the lungs).”

Most of the time a pulmonary function test of which the spirometer test is the most common, is used first. It is a test that measures how much air you can inhale as well as how fast you can exhale. Sometimes a bronchodilator is given to see how your lungs respond to the med and spirometer testing can even diagnose a person properly before any signs of COPD occur!

Other tests include a chest x-ray, CT scan and sometimes arterial blood gases in order to give the physician a firm diagnosis.

What Is The Treatment For COPD?

Because there is no cure at this time for COPD, the goal of treatment is to treat the symptoms as they appear. However, many people are able to decrease worsening of the disease and improve the ability to perform activities of daily living with the implementation of lifestyle changes such as stopping smoking and following their physician suggestions for medications, balancing nutrition, and exercise.

Medications for COPD may include bronchodilators in the form of an inhaler to help prevent coughing and shortness of breath. Some bronchodilators are used daily and are long acting while others may be used on an as needed basis and those are called short acting bronchodilators. Some common short acting bronchodilators include pro aire, albuterol, or xopenex. Examples of a long acting bronchodilator are Salmeterol (Serevent) and Formoterol (Formoterol). However, Fomoterol (Foradil) is also part of the group of inhalers know as combination because it contains both the bronchodilator and a steroid.

Some consider Spiriva to be a short acting bronchodilator and it is longer acting than say ipratropium which many people use as part of their nebulizer treatment but Spiriva is generally considered to be a maintenance or long acting bronchodilator.

There are also inhaled steroid based inhalers that can help prevent worsening of the disease. Some examples include Fluticasone Propionate (Advair or Flovent) and Budesonide (Pulmicort).

There are also inhalers that combine both a steroid as well as a bronchodilator. One example of this type of inhaler is Fomoterol (Foradil) as mentioned earlier and Budesonide (Symbicort) as well as Fluticasone Propionate (Advair or Flonase) of this type.

All medications regardless of the way they are delivered to your body do carry risks and some risks increase depending on how long you use the medication. Some side effects of using steroids include increased appetite, increased weight gain and increased risk of developing type II Diabetes. However, the best rule of thumb is to always talk with your physician about every medication that is ordered for you and make sure you understand your medication and any effects that may occur.


Other Treatments That Can Help You Manage COPD

Your physician may also order oxygen for you or pulmonary hygiene or rehabilitation. Oxygen is sometimes given to persons with COPD when an infection is present or if COPD worsens. Pulmonary hygiene or rehabilitation may include things such as deep breathing exercises, exercise to help improve your lung function, information and suggestions to improve your nutrition and quality of life. Sometimes just a regular deep breathing exercise that you do on a daily basis can improve your lung function so do not discount a small thing like taking deep breaths on purpose as a way to feel better and stay healthy!

There may be times when all you do to remain in good health may not be enough. Do not get discouraged. Always listen to your body and do not put off calling and or seeing your physician if your lung function and breathing become worse. The faster you see your physician, even if you feel it is ‘just a little cold’ the faster you will get back to feeling good once more. With COPD, just a little cold can quickly become much worse and an exacerbation can lead to an unwanted and prolonged hospital stay.

An excellent illustration of bronchi with and without this condition

Source

What Are Some Signs and Symptoms of Bronchiectasis?

Of all the symptoms the one that is repeated by all sources is a productive cough with copious amounts of phlegm (mucus) that occurs on a daily basis. The colour of the mucus can be yellow or green and may have blood in it as well. The odor of the persons sputum may have a foul odor and the sputum itself may be thick, sticky, or in other words, viscous. Other signs may be shortness of breath, wheezing, clubbing of the fingers and toes and chest pain. Clubbing is where the skin under your nailbeds become thicker however, clubbing is seen in other disorders as well. Weight loss or the inability to gain weight, especially with children, as well as fatigue and repeated lung infections in the same locations in the persons lungs are also signs of bronchiectasis. So, if a person has pneumonia and the chest xay shows it as being in the same place every time, your physician may suspect that it is bronchiectasis and not just pneumonia that is the underlying issue. At times, there may be an elevated temperature, weight loss as mentioned earlier, and weakness.

What are the causes of Bronchiectasis?

An article from Medscape.com gives the following definition: “Bronchiectasis is an uncommon disease, most often secondary to an infectious process that results in the abnormal and permanent distortion of one or more of the conducting bronchi or airways.”

The National Institute of Health states that bronchiectasis often starts in childhood from things such as whooping cough (Pertussis), pneumonia, or measles. However, although bronchiectasis might start at that time it may not show up or manifest itself until later on down the road, sometimes years from the time of the initial illness that started it! This condition may affect one side of the lung or both, although NIH states that is usually in only one side of the lung due to the person having inhaled something which is known as aspiration. The British Lung Association (BLF) also uses aspiration as a specific cause of Bronchiectasis. Many times children aspirate small objects, like a toy, or food, even something as small as a peanut can then cause issues later on as the child grows.

NIH also states that bronchiectasis is caused from a condition where the walls of the airway (Bronchi) are injured in some fashion and that is what causes the problem of the person being unable to clear the mucus by coughing.

Bronchiectasis can also be congenital. Cystic Fibrosis (CF) is one medical condition where the person may also have Bronchiectasis and often, if a person is suspected of having bronchiectasis the physician will run a test specifically for Cystic Fibrosis. It used to be thought that CF was only seen in young children however, it has been found that CF can show up or manifest itself later in life, even as an adult and more people are now being diagnosed with cystic fibrosis in later years.

Another inherited respiratory disease is Primary Ciliary Dyskinesia where the tiny hairs (Cilia) that line the bronchi do not function as they should and that makes it harder to bring up phlegm which then leads to bronchiectasis.

NIH goes on to state that Tuberculosis, Rheumatoid arthritis, Crohns Disease and Sjorgens can lead to Bronchiectasis. NIH also states that acquired is more common than congenital Bronchiectasis.

Sometimes a person may have an autoimmune disorder where the persons immune system is not able to produce antibodies to fight off infection.

Another cause of Bronchiectasis is aspergillus, which is a fungal infection. It usually affects the respiratory system and a lot of times this is found in persons who are asthmatic. The mold that causes aspergillus is fairly common and usually doesn’t cause any harm but if a person has asthma or if the person has an immune system that is weak or compromised then aspergillus can lead to repeated lung infections.

The British Lung Association (BLF) points out is reflux can lead to Bronchiectasis because with gastric reflux if the acid in the stomach comes up into the trachea, there is a higher risk of aspiration and that acid gets into the persons airway (Bronchi) and if it isn’t treated can over time cause this disorder.

The British Lung Association (BLF) also points out that sometimes a reason cannot be found and that is known as Idiopathic Bronchiectasis.

How Does Bronchiectasis Feel?

Perhaps the easiest way to imagine how this makes people feel is to think of having a really bad cold with a lot of coughing and a lot of mucus and imagine that you never get well. Your daily life then would evolve around coughing and trying to spit or get rid of the mucus in your lungs.

How is Bronchiectasis Diagnosed?

Your physician will take a physical assessment, listening to your lungs as you breathe with his or her stethoscope as well as a Chest XRAY and sometimes a computerized tomography (CT) scan of your lungs. Your physician may perform blood work to check on the number of white blood cells because if your WBC is elevated it can mean you have an infection. There may also be sputum cultures ordered to determine if there is bacteria or other organisms such as mold already present. However, it really depends on what is going on with your health at the time of the physicians assessment and your physician will be able to determine from his assessment what tests are necessary in order to give you the best options and highest quality of care.

What Is the Treatment for Bronchiectasis

As with COPD, there is no cure at this time. Treatment consists of treating the episodes of infection as they appear, prevention of infections with good hygiene, treatment of recurring infections with antibiotics, bronchodilators, and most importantly daily pulmonary hygiene.

Pulmonary hygiene or toilet is also done for persons with cystic fibrosis and anyone can do this for themselves. It can help reduce the amount of phlegm if it is done on an daily basis. Pulmonary toilet is simply a way to let gravity do what it does best, which is to get fluid to run downhill. Think of it this way; your lungs will have the largest amount of secretions settling to the bottom. Coughing can help bring up some but if you were to, say, stand on your head then gravity would help bring even more mucus come out of your lungs. However, standing on your head is problematic at best so how about if you tried another way. First drink about 4oz of water because water will help thin the secretions in your lungs. Just don’t drink too much or it might make you a bit queasy during this next part of your pulmonary toilet. Lay on your bed crosswise so you head is hanging off the side. Try and let your head hang as far off the side of your bed as possible without sliding off and take some big breaths, really good deep breaths and make yourself cough. If possible, enlist the help of your friend or a family member and ask them to rub your back or have them cup their hands and lightly tap with their cupped hands from the bottom of your back all the way to your neck. This is called ‘clapping’ and it’s done a lot of times for people and children who have impaired breathing such as with CF. When children are small and have a cold, laying the child across your lap and gently tapping their back will help them bring up the mucus when they have a cold. You may have done something similar if you had children. This is all part of your daily tasks that will help you breathe easier, decrease the amount of phlegm and may even help prevent infections.

Conclusion

Both COPD and Bronchiectasis are not curable at this time.

Persons with both COPD and Bronchiectasis are prone to respiratory infections and have a higher risk of aspiration although the risk of aspiration is present for persons with Bronchiectasis from an earlier age and is one of the known causes as opposed to persons with COPD where the underlying cause may be environmental and or cigarette smoking.

Persons with COPD can develop Bronchiectasis especially in later years because of the increased risk of aspiration as well as risk of repeated lung infections.

It is not usual that a person with Bronchiectasis would develop COPD.

Persons with COPD generally have white, frothy mucus that is without odor unless they have an active respiratory infection. The mucus may be a larger amount when they first wake up in the morning

Persons with Bronchiectasis have thick, occasionally foul smelling mucus that is yellow or green coloured mucus that they cough up in copious amounts on an ongoing basis.

Persons with COPD have damaged air sacs (alveoli)

Persons with Bronchiectasis have damaged airway (Bronchi)

Persons with COPD may benefit from using short and long acting bronchodilators.

Persons with Bronchiectasis may benefit from daily pulmonary toilet, good personal hygiene, expectorants, antibiotics as needed as well as bronchodilators as needed.

In looking at this information it would seem the differences outweigh the similarities. Persons with COPD may well have Bronchiectasis but it is rare that persons with Bronchiectasis would also have COPD. The part of the lung that is damaged are also different; the alveoli in COPD and the Bronchi in Bronchiectasis. The risk of recurrent infections may be similar but persons with Bronchiectasis are at higher risk earlier in life than a person with COPD. The biggest difference would seem to be in the treatment of each condition. Although both conditions may benefit with the use of bronchodilators, the importance of pulmonary toilet is heavily stressed with Bronchiectasis as compared to COPD.

Another way to think of it is with the condition of COPD and bronchiectasis then the co morbidity. That is possible, as bronchiectasis is seen at times in persons with COPD. But can COPD be considered a comorbidity in bronchiectasis? That is less likely.

Another way to think of it is with the guidelines set forth by Medicare, or the American Lung Association. In America, COPD is only chronic bronchitis and Emphysema. In other countries, other respiratory conditions are associated with COPD, but not in the United States. At this time, only chronic bronchitis and Emphysema are the conditions known as COPD.



Sites With More Information

It can be difficult to sort through the information on any subject through the internet. Of course, your physician is your first source for expert advice, and other sources of reliable information include Mayo Clinic, National Institute of Health, and the American Lung Association. Other sites can also be helpful such as the British Lung Association, and Medline Plus. Many large hospitals and clinics also have websites that can provide excellent resources and one site that comes to mind is the University of Chicago Medicine website but as mentioned earlier, your physician is the first and best source for all questions related to your health.

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