Bronchiectasis means that large infected cavities have developed in the lungs. It is a chronic disease, often starting during childhood and following on from an infection. Whooping cough, measles, bouts of influenza or pneumonia may have been the predisposing infection. Small cavities of the lung are infected, and this usually spreads gradually. Although the general health of the child may originally have been good, a chronic loose cough becomes established. At first it may be apparent only in the mornings or the evenings. When the child runs or exerts himself, there may also be some breathing difficulty. He gets out of breath easily. Gradually, as it develops, he may lose weight and also lose general health and vitality.
Older children tend to develop a cough and bring up large quantities of foul-smelling sputum. Often there is a mild fever which waxes and wanes. In long-standing cases the doctor notices that the fingers become clubbed. (This means the normal ends of the fingers are more rounded.) Many children become anaemic, pale and obviously in deteriorating health.
Treatment
Most doctors believe that bronchiectasis can usually be prevented by adequate treatment of any respiratory disorder. Upper respiratory tract infections, bouts of the flu, coughs and colds, bronchitis, pneumonia, removal of foreign bodies—whatever the cause and nature of the respiratory disorder—if this is treated adequately and completely until a full recovery has taken place, then the risk of this hapless and debilitating chronic disease is not nearly so high. It is salutary advice which parents would do well to follow.
Treatment must be under the proper care of a doctor or hospital where full facilities are available, and where ongoing care and advice can be offered. Lengthy hospitalization is usually not needed, and much of the care can be given at home by the parents.
In the early acute stages, when diagnosis is being established, hospital care may be needed. Antibiotics, aerosol bronchodilators, postural drainage and breathing exercises all form an important part of treatment. Adequate nutrition is also important. Sometimes diseased tonsils or adenoids may require surgical removal, or sinus drainage undertaken. In severe cases, when the disease is confined to a particular lobe of the lung, removal of the lobe may be advisable.
The crux of ongoing home treatment is the postural drainage and breathing exercises routine. This is aimed at removing as much debris from the lungs as possible, and opening up the air passageways to enable as much oxygenation as possible of the lung tissues. The routine may be continued for many months, for years, or possibly for a lifetime.
There is often no simple do-it-yourself cure for bronchiectasis. It usually is diagnosed in hospital, and treatment and ongoing care must often continue for a considerable period of time. Parents should make certain they carry out full instructions to the best of their ability. They should also explain to all their children (especially older ones) the nature of the problem and the need for continual co-operation. Without this, it becomes an even more difficult medical problem.
In early stages, moderate bronchiectasis is often completely curable. However, some cases continue for many years and require ongoing management under the experts.
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