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Appendix B Bronchiectasis
I suppose many people wonder how they have come to have two lung diseases for the price of one. How does bronchiectasis happen?
When we develop plugs in our lungs from ABPA they lodge in our bronchial tubes. The mucus becomes jammed in there quite tightly and this causes the affected bronchial tube to literally stretch out of shape. It can almost look like a little balloon. You may be able to clear the plugging out eventually but the bronchial tube never really resumes its original shape. It has been permanently damaged. This can happen in many different areas of the lungs and I have had many different plugs in many sections and I have fairly extensive bronchiectasis. Most people with ABPA develop bronchiectasis from repeated plugging episodes. The best thing to do to minimize this is to use prednisone as best you can to keep the plugging to a minimum. The more bronchiectasis you develop the more problems you are going to have. These problems include decreased lung functions and increased susceptibility to infection. The loss of elasticity from the stretching makes it harder to breathe efficiently. Most of us have asthma too so that is a double whammy. We also are more prone to infection because of this because the lung's ability to clean itself is impaired by the distension. That is because it is hard to cough stuff out of the affected areas and these areas are more likely to accumulate mucus.
At a certain point some people can evolve from this into pulmonary fibrosis and end stage lung disease but this is not necessarily true in any particular case. I am now 45 years old and have had bronchiectasis since at least age 10 and no one has ever told me that I am going in that direction. My lung functions are certainly impaired but I am still in an upright position most days.
I have had severe bronchiectasis going back to childhood and I am infection prone because of this. I take antibiotics approximately once a month to manage this. You may also find some blood in you sputum occasionally due to this. However any time you cough up any significant amount of fresh blood you should be seen immediately on an emergency basis since this could be something more serious than just small amounts of usually drier blood that can go with having bronchiectasis. I believe that in my particular case episodes of pleurisy and chest wall pain are also connected to having bronchiectasis as well as being attributable to the inflammation and exascerbations of ABPA. Anyone out there who has received a diagnosis of bronchiectasis can probably be certain that this reflects the disease activity of ABPA for a period of time that is probably more likely to be a period of years and not weeks or months. These are things that I have been told by various doctors over a number of years.