When your lung health is compromised, it influences your overall health and can prematurely decrease your lifespan. However, future research on lung health is bright.
Why? Because researchers, medical professionals, and patients alike are keen on understanding these conditions. With research and awareness, it is more likely that we can break the barriers surrounding chronic lung conditions.
Bronchiectasis is a chronic lung condition that greatly impacts one’s quality of life through breathlessness, coughing, phlegm production, tiredness, and an increased likelihood of chest infections.
In the spirit of creating awareness, this year, on July 1st, 2022, the inaugural World Bronchiectasis Day was held. The goal is to promote awareness, share knowledge, and explore solutions to reduce the impact of bronchiectasis on patients and their families around the world.
On Sunday, March 27th, the Bronchiectasis Patient Conference 2022 was held online. It was primarily concerned with treatment and self-management.
Additionally, we had the pleasure of inviting Dr. Mindaugas Galvosas, one of the online participants at the conference, to a virtual interview to share what was discussed at the event. Dr. Mindaugas Galvosas is a medical doctor working with Acoustic Epidemiology and AI-based continuous cough monitoring at Hyfe. He has previous experience in digital health technologies, non-governmental organizations, global health, and pharmaco-vigilance.
MS (Marion Sereti): What is bronchiectasis, and what causes it?
MG (Dr. Mindaugas Galvosas): Bronchiectasis is defined by abnormal dilation of the bronchial tree due to repeated bronchial inflammation and also incomplete clearance of secretions from the lungs. This dilatation of the airways is irreversible and can be caused by severe and chronic pulmonary infections; also disorders where secretion clearance is impaired – for example, cystic fibrosis or primary ciliary dyskinesia.
Additionally, bronchiectasis can be a result of persistent airway obstruction in diseases such as COPD, tumors, congenital deficiencies (e.g., alpha-1-antitrypsin deficiency), or malformations (e.g., tracheomalacia).
MS: Which symptoms should we be aware of in relation to bronchiectasis?
MG: Chronic productive cough – lasting months to years – accompanied by mucus and pus (mucopurulent phlegm) in the sputum (which might be yellow or green) are the main indicators of bronchiectasis. People with a chronic cough that produce large amounts of sputum need to be aware and seek healthcare.
MS: Coughing is a major symptom of bronchiectasis. How can we identify and manage this symptom?
MG: The cough in bronchiectasis is continuous and chronic – people notice it lasting months to years.
For example, people with COPD who develop bronchiectasis could have frequent exacerbated coughing events with lots of sputum production. Or it could be a chronically recurrent pulmonary infection.
The disease is also identified by characteristic auscultation findings (crackles and rhonchi, and wheezing when the medical practitioner listens to a patient’s chest); imaging studies are needed to confirm the diagnosis. Additional tests are done to identify the underlying cause (is it infectious/malignant? etc.), so as to prescribe appropriate treatment.
It is quite a paradox that a long-lasting cough is the major symptom of bronchiectasis specifically, yet until recently there was no way of objectively quantifying coughs (e.g., for how long and how much does a person cough) in routine clinical practice. It was all based on reporting by the patient.
The good news is that passive cough monitoring with sophisticated artificial intelligence (AI) technologies that enables cough quantification is now available on smart devices, such as phones and home speakers.
MS: What non-pharmacological methods exist for the treatment of bronchiectasis?
MG: First of all, lifestyle changes are very important – regular physical activities are encouraged, and smoking cessation is necessary for the best possible outcomes.
There are also various airway clearance techniques that patients should be educated about, usually after a referral to a respiratory physiotherapist – postural drainage, cupping and clapping, and more. With appropriate treatment and interventions preventing further damage and infection in the lungs, people can live a normal life.
These methods are recommended in long-term treatment, while acute exacerbations and the underlying causes of bronchiectasis (e.g., a severe chronic infection) should be treated immediately with pharmacological interventions, ensuring adequate oxygen supply.
In very severe cases (if pulmonary hemorrhage is present) surgical interventions might be required.
MS: What should we know about bronchiectasis in a COVID-19 world?
MG: The COVID-19 world has resulted in some challenges for bronchiectasis patients and for care in COVID-positive patients. Fear of coughing as one of the top-5 symptoms of COVID-19 has resulted in a huge stigma surrounding bronchiectasis patients and other chronic coughers.
Additionally, bronchiectasis patients were shown to exhibit a more severe COVID-19 disease course and have higher mortality compared to healthy people without chronic respiratory diseases.
MS: What are the main misconceptions about bronchiectasis?
MG: A very common misconception is that bronchiectasis is caused by smoking. To many people’s surprise, it is not. In fact, for many people with bronchiectasis, the cause is not known.
MS: The psychological aspect affecting patients with chronic illnesses can not be overlooked. How is the mental health and well-being of people living with bronchiectasis approached?
MG: The psycho-social aspects of bronchiectasis are of utmost importance and were stressed by some patient testimonies at the Bronchiectasis Patient Conference this year.
People with chronic airway diseases more commonly experience mental health issues than the general population. Moreover, such coexistence of mental health comorbidities negatively affects clinical outcomes — they can lead to the worsening of symptoms, more frequent exacerbations, poor adherence to treatment, and increased levels of mortality.
Another interesting insight from the conference is that living with a partner is a risk factor for developing depression in people with bronchiectasis due to the fact that the disease is very tough to care and manage. Additionally, it is very important that patients stop carrying all the mental burden on their own — seeking help and support for mental health issues should be encouraged by healthcare professionals and family members.
It was also noted during the conference that, healthcare professionals should be spending more time discussing topics such as diet, lifestyle, and mental health with their bronchiectasis patients.
MS: How can the global burden of bronchiectasis be minimized for patients and their families?
MG: Physicians should spend more time talking about the illness and let patients ask any relevant questions. We see that patients want to understand their condition through more time with a professional, where they can learn about and discuss holistic treatment approaches. Mental health services should also be made available and encouraged.
MS: What kinds of research are out there and why should people take part in it?
MG: There are quite a few ongoing clinical trials with new pharmacological substances that have potential for the treatment of bronchiectasis. Also, some humidification and physiotherapy devices are being explored.
Joining bronchiectasis trials is contributing to research and moving science forward. It might not only help the participant with access to the newest treatment and detailed care from the trial staff, but also help others, if the trial is successful in showing efficacy.
Every piece of data from a bronchiectasis patient could have a huge value in the final analysis when added to the pool of other patients with similar backgrounds, environments, and demographics.
MS: What do you believe are the most important steps for people to take if they are diagnosed with bronchiectasis?
MG: The most important steps are to follow the general measures of bronchiectasis management, as previously mentioned: implement recommended lifestyle changes and quit smoking to prevent further airway damage.
Pulmonary rehabilitation activities, such as walking, cycling, and strength exercises, could be helpful in improving respiratory symptoms and increasing exercise capacity.
Moreover, seeking advice and learning about potential mental health challenges is key in preventing the worsening of the disease and dealing with the potential psychological burden of chronic respiratory disease.
MS: What are your thoughts on the Bronchiectasis Patient Conference?
MG: It was a very interactive and informative online event. More than 500 people joined the conference, and many topics, such as airway clearance, diet in managing symptoms, social challenges, and various treatments, were discussed.
I was also involved in the Q&A sections and following discussions. One question that I asked, which sparked a discussion, was “What could be the future role of acoustic AI in remote patient monitoring in bronchiectasis?”.
Prof. James Chalmers replied that it is indeed an interesting question and it would be interesting to see some research in it. Dr. Arietta Spinou replied and later shared in the conference her experience with 24h cough monitoring for few bronchiectasis patients – it showed that people with bronchiectasis cough more than healthy people, as measured objectively.
More steps should be taken in making it an outcome measure, and a recent publication highlights that novel AI smartphone-based longitudinal cough monitoring is a more valuable method than 24h cough monitoring, which can be misleading in some cases.
MS: What is your advice for people who have been diagnosed with bronchiectasis and are considering attending such conferences?
MG: I recommend attending these free events, as many useful evidence-based resources and recommendations are shared and discussed. There was another event chronic cough patient conference by the European Lung Foundation in May – which invited patients and fellow colleagues to participate and has now recorded sessions available for watching.
Good practice examples and novel methods in the field of cough were shared in this conference – worth a watch!
Although there is no cure for bronchiectasis, early diagnosis and treatment can improve people’s quality of life while also minimizing or preventing lung damage. Airway clearance therapies, in addition to pharmaceuticals, are an effective and safe therapy option. Further improved therapy options for bronchiectasis are now being researched and tested in clinical studies.
While you keep an eye out for early indicators of a flare-up, it is important that you track your cough to stay on top of your health.
If interested, full sessions from the bronchiectasis patient conference 2022 by European Lung Foundation are available on the event page.