Problem of Persistent Cough and Phlegm

Dr K K Pandey
Have you ever caught infection of pneumonia during your childhood days? If yes, the infection then might have been brought under control to some extent with effective medication but in the end you started having bouts of recurrent coughs. The fever though has subsided after treatment but complaint of cough and passing of phlegm still persists. This might also have happened to you that your lung caught T.B. infection, which was controlled after a few months of antitubercular treatment, but the cough still persists even after T.B. infection got cured. Have you been suffering from recurrent coughs and passage of phlegm since the age of 14? Sometimes you might have spitted out blood along with sputum and on some occasions, the amount of blood spitted out was significant. Now there is no fever, but continues the problem of coughing and phlegm, which increases in amount especially during winters. All these complaints lead to one suspicion; probably you are suffering from bronchiectasis of lung. Take this disease of bronchiectasis seriously right now, otherwise you might face unpleasant and tormenting complications in future.
What is this disease of bronchiectasis all about?
Bronchiectasis is the other name of chronic infection and inflammation of branches of wind pipe existing inside the lung. In this condition of bronchiectasis, the wall of wind pipes due to infection and inflammation becomes unusally weak. On account of these changes, branches of wind pipes no longer are able to maintain their tubular shape and in the process assume abnormal shapes like that of balloon or cylinder. This weakened wall of windpipe is unable to throw out the sputum collected inside the branches of wind pipe. This results into accumulation of a large amount of phlegm inside the wind pipe. This stagnation of sputum blocks the tubes as well as branches of wind pipe connected to lung tissue. Because of obstruction, the part of the lung supplied (attached to) by these tubes, gets damaged and constricted due to destruction. This leads to a state of inflated lung like a balloon. The lymph nodes and blood pipes adjacent to destroyed lung also become enlarged. The net result of these changes is that the damaged lung as well as wind pipe are unable to function properly and the affected patient develops a lot of complications.
Why does a bronchiectasis occur?
In African countries, the main reason of developing bronchiectasis is the recurrent infection in wind pipe and its branches. The main cause of recurrent infection of lung is the infection of pneumonia. If pneumonia is not controlled effectively in its early stages, the problem of bronchiectasis of lung may emerge in a due course of time.
The second important reason of development of bronchiectasis is the tubercular infection. After proper medication, although tubercular infection leaves the lung, but before leaving, it makes a lasting impression on lung and wind pipe. As a result, the anatomy of these structures undergoes a change. This alteration in anatomical structure helps other types of germs to settle there inside permanently. These germs start disturbing the normal function of wind pipe. This is where the disease of bronchiectasis starts. In some persons, the bronchiectasis of lung is present since birth. In children, the common cause of bronchiectasis is generally due to cystic fibrosis, a congenital disease.
Sometimes, deficiency in blood of a special enzyme called Alpha-1 antitrypsin, presence of rheumatoid arthritis and other autoimmune diseases become important causes of development of bronchiectasis. Generally children are in a habit of putting small things like peanuts, coins, fish bones in their mouth. These small things when swallowed by children sometimes, actually enter the wind pipe instead of entering the food pipe and thereafter it blocks it while going down the wind pipe.. At this point, part of the lung supplied by the blocked pipe start developing bronchiectasis.
How to suspect the disease of bronchiectasis?
* Recurrent chest infections
* Breathing difficulty
* Recurrent episodes of unrelenting cough which disturbs you a lot
* Passing of a very thick and pus-like phlegm during coughing
* Sometimes a cough bout lasts longer and there appears a gurgling sound during breathing
What to do if you are suffering from bronchiectasis?
If you are a sufferer of bronchiectasis, consult immediately a thoracic surgeon and always go to a hospital where facility of modern investigations like broncoscopy, thoracoscopy, spiral CT, angiography and bronchial artery embolization is available. The role of chest x-ray and spiral CT is very significant in evaluation of bronchiectasis. On the basis of these results, we can say with surety which part of lung and wind pipe is diseased and destroyed. All these informations help formulating the correct treatment strategy for bronchiectasis.
What is the correct treatment of bronchiectasis?
A patient suffering from bronchiectasis, should either on his own consult an experienced thoracic surgeon or request his treating physician to arrange consultation with a thoracic or chest surgeon. It has been observed in India that the surgeon who is more involved with heart surgery does not have much experience with lung surgery. Therefore, one should go to a hospital where lung surgery is routinely done and 24-hours availability of a full-time thoracic surgeon is there.
For the successful and effective treatment of bronchiectasis, it is essential to find the cause of it. For the purpose of effective treatment the correct use of antibiobitic is most desirable thing. All efforts should be put always towards removal of sputum from damaged wind pipe. Some special medicines like bronchodilators, and mucolytic agents have proved effective to some extent. Some special physical postures and physiotherapy are helpful in effective removal of phlegm.
Important role of surgery in the treatment of bronchiectasis
Surgery plays an important role in the treatment of bronchiectasis. If any part of lung has been already destroyed due to bronchiectasis, it is a wise step to get that damaged part removed by a thoracic surgeon, otherwise the healthy part adjacent to damaged one will get diseased.
(The author is Senior Thoracic & Cardiovascular Surgeon Indraprastha Apollo Hospitals Sarita Vihar, New Delhi)