Guest: Dr. Anne O’Donnell
Presenter: Neal Howard
Guest Bio: Dr. Anne O’Donnell is the Division Chief of Pulmonary Medicine, Critical Care, and Sleep Medicine. She is also the Medical Director of the Sleep Disorders Center at Georgetown University.
Segment overview: Dr. Anne O’Donnell, pulmonologist, talks about non-cystic fibrosis bronchiectasis, causes, symptoms and treatment.
Health Professional Radio
Neal Howard: Hello and welcome to the program, I’m your host Neal Howard. Thank you for joining us here on Health Professional Radio. Our guest today is Dr. Anne O’ Donnell, Division Chief of Pulmonary Medicine, Critical Care and Sleep Medicine, also Medical Director of the Sleep Disorders Center at Georgetown University. And she’s here today to talk with us about NCFB, treatments and symptoms. Welcome in the Health Professional Radio Dr. O’Donnell.
Dr. Anne O Donnell: Thank you.
N: What exactly is NCFB?
D: It is mouthful (laughs). Its non-cystic fibrosis bronchiectasis, I think we could just call it bronchiectasis going forward. It’s kind of a spectrum of disease where there’s an abnormality in the lungs which we characterizes bronchiectasis. Meaning scar tissues that bronchial tubes are abnormally enlarge and kind of harbor excessive mucus and then there’s a vicious cycle where there’s inflammation followed by infection, followed by more inflammation. The disease itself is really anatomic abnormality of the small airways in the lungs, and then infections can result in those airways that complicate that anatomic abnormality.
N: So an anatomic abnormality. Is that caused by something say smoking or inhaling some type of irritant? Or it can just be the cause simply due to your genes?
D: Yes, there’s a number of causes of bronchiectasis, in general it’s not really a smoking related disease although occasionally it can be related to smoking so it’s not the same thing as COPD or emphysema. There are a number of significant genital abnormalities that people are born with that cause bronchiectasis and cystic fibrosis is one. But there’s a few others disorders like ciliary, abnormal cilia that can do it. Also things that patients acquire like immune deficiencies can cause bronchiectasis. But most of the time it’s either because of a bad infection in the lungs in the past or we actually don’t identify a specific cause for the bronchiectasis and then we call that ‘Idiopathic Bronchiectasis’.
N: You mentioned this vicious cycle of inflammation, infection then inflammation again. What are the some of the treatments prior to these flare-ups?
D: Yes, we often really try to identify what bacteria might of complicated the bronchiectasis and so then we can target that particularly when the patient does have a flair-up of their symptoms. But prior to having the deal with antibiotic, we like to recommend what we call, ‘Airway Clearance’ which is just basically trying to clear out the mucus from the airways. Either by exercising or by doing some physical techniques that help move the mucus out of the small bronchial tube. That’s kind of the underpinning of our treatment in before we get into the more complicated thing.
N: What are the numbers as far as people that are affected by NCFB?
D: Yes. Probably in the United States it’s about at least a hundred thousand patients. It’s a relatively rare disease, but it’s is something that we actually are recognizing more and it has been diagnosed more frequently. Probably because the disease is actually increasing in frequency but also our ability to diagnose it has gotten better over the past few years.
N: You mentioned that it’s not like a COPD. Is it misdiagnosed often even though it’s rare? Is it misdiagnosed quite a bit, or is that something that is a rarity?
D: Yes, no it’s often is confused initially with COPD or even asthma, and really the way we pin down the diagnosis is first of all to kind of elicit the symptoms from the patient. Patients usually complain that they have kind of non-relenting cough and they often produce sputum, mucus and they have frequent infection. But we actually confirm the diagnosis by doing a CT scan of the chest and then it’s actually very easy to diagnose with that scan. We also sometimes prescribe some sort of device, a little apparatus which patients can breathe and it helps them to cough, and move their mucus out of their lungs. Sometimes we also prescribe a salt water inhalation, again to help break up the mucus and move it out. When the patients are more symptomatic and more likely to have a flare-up, then we get into some sort of chronic antibiotic for those patients.
N: What about the over the counter expectorants for milder symptoms?
D: Yes, there is a role, although it’s not that well scientifically proven for many patients to use over the counter medication like guaifenesin which again is something that helps thin the mucus and make it easier to cough. That can be helpful for patients in the over the counter range. Some patients have other like allergies associated with those and those patients sometimes benefit from taking an antihistamine, an over the counter antihistamine.
N: Now this is something that can be passed on from person to person, isn’t it?
D: No. It may not can be passed on because the family members may have a genetic predisposition to it and hence the genetic pass down. No it’s not contagious, it’s not something that one person can give to another in that sense. It’s not contagious at all.
N: Now these abnormalities in the bronchial tubes that you talked about, is this something that is present in your early life and then manifest with problems later on or is this something that can strike at any age?
D: Yes, so both scenarios happen. Some patients are literally born with this disease or at least born with the predilection that develops this disease and those are people young infants and children who have some sort of genetic predisposition to it or have a something wrong with their immune system. But otherwise it can really happen at any age, we tend to see it more in older patients particularly also women more than men but it can happen at any age pretty much across the spectrum of age.
N: When it comes to preventing these flare-ups, now you mentioned the clearing, the tube clearing, the simple walking and exercising and sometimes a device. How often is a simple changing in an environment, something that offers a great deal of relief?
D: In terms of changing the patient’s environment?
N: Yes. Maybe there’s (crosstalk)
D: Yes, it’s not usually an environmental disease at all. Some patients definitely feel worst at extremes of heat and cold in terms of climate. We know that some of the infections that complicate bronchiectasis are more common in areas of the world that are more humid so pint that sense we’re trying to avoid excessively humid environments might help. But in general, it’s not really an environmentally related disease.
N: Does there seem to be one infection in particular that seems to strike most often among infections associated with this disorder?
D: Yes, that’s a great question and it’s sort of points out the fact that we need in each individual patient look to see what bacteria maybe infecting them. It’s really important that we do a culture of their mucus or their sputum. But across the board, the most common bacteria is one called, Haemophilus, which is a common respiratory bacteria but there are other bacteria that might infect these airways like another relatively common one that something called ‘Pseudomonas’ and that demands a particular type of antibiotic in order to treat it.
N: Where can our listeners go and get more information?
D: Some good websites, the National Institute of Health has a patient facing website that really gives some good information about this disease and some pictures that help people understand about this disease. And there’s some other groups the Mayo Clinic, National Jewish Health have websites that help to explain this disease to the patients, sort of patient facing websites like that.
N: Well I thank you for talking with us today Dr. O’Donnell.
D: Alright, thank you very much.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard with Dr. Anne O’Donnell talking about NCFB. Transcripts and audio of this program are available at helathprofessionalradio.com.au and also at hpr.fm and you can subscribe to this program on iTunes and listen in on SoundCloud.