In order to raise awareness of bronchiectasis—and to support patients through diagnosis and care—we must first understand this disease state.
What is Bronchiectasis?
by Bryan Pearson, RRT
Frontier Home Medical Clinical Representative
The American Lung Association defines bronchiectasis as “A chronic condition where the walls of the bronchi are thickened from inflammation and infection. People with bronchiectasis have periodic flare-ups of breathing difficulties, called exacerbations.” We see two types of bronchiectasis, Cystic Fibrosis and idiopathic bronchiectasis. For those who suffer from non-cystic fibrosis bronchiectasis little is known to why this develops. Some people that may be at an increased risk for developing bronchiectasis are those with a history of lung infections, which have left scar tissue throughout the lungs, those who suffer from immune system conditions. Genetic diseases like alpha-1 antitrypsin deficiency or ciliary dyskinesia have been seen to develop bronchiectasis.
Bronchiectasis in Primary Care
In a “Journal of Community Nursing” article by Shirley Pickstock, she outlines the complexity of bronchiectasis and how it can, if left untreated, impair your patients’ quality of life. Better understanding of signs and symptoms can lead to diagnosis.
“It is important for clinicians to have an awareness of the possible causes and disease overlap in order to identify and treat patients with bronchiectasis effectively, with comprehensive history-taking being paramount. The majority of respiratory tract infections in primary care are self limiting, however patients presenting with persistent cough and daily production of a large volume of sputum with recurrent infections should alert clinicians to the possibility of bronchiectasis. Patients may also report breathlessness, chronic rhinosinusitis, haemoptysis, fatigue, pleuritic chest pain, and, in more severe cases, weight loss (National Institute for Health and Care Excellence, © 2018). On clinical examination, there may be coarse crackles, wheeze, large airway rhonchi (low pitched snore-like sounds) on auscultation of the chest, and finger clubbing may be present (Bourke and Burns, ‘Lecture Notes: Respiratory Medicine’, © 2015).”
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Obstructive Sleep Apnea May Be One Reason Depression Treatment Doesn’t Work
Publication: Mental Health Weekly Digest
Study Author: Dr. W. Vaughn McCall, chair of the Department of Psychiatry and Health Behavior at the Medical College of Georgia at Augusta University
Publisher: NewsRX LLC
According to recent findings, there may be a link between unsuccessful treatment of depression and undiagnosed obstructive sleep apnea (OSA). When a patient has treatment-resistant depression, sleep testing is warranted; even for those who do not fit the usual criteria for sleep apnea.
“[Dr. W. Vaughn McCall] found clinically relevant disease in 14% of 125 adult patients with major depressive disorder, insomnia and suicidal thoughts, even though the sleep-wrecking apnea was an exclusion criterion for the original study. While more work remains, McCall reasons that the new evidence already suggests that testing for obstructive sleep apnea should be part of the guidelines for managing treatment resistant depression.”
Dr. McCall’s original study focused on treating insomnia and depression in tandem, in order to reduce suicidal thoughts. There were 125 people enrolled in the study. Of those, 17 tested positive for OSA.
“Forty-four percent of the 125 patients in this study had treatment-resistant depression and four of the 17 diagnosed with obstructive sleep apnea had severe problems. Most with obstructive sleep apnea were in the upper end of the age range of 18 to 65 — sleep apnea and other sleep problems tend to increase with age — and were similar in other respects like sex and weight.”
Sleep apnea tends to produce excessive daytime sleepiness but this study was recruiting for patients with insomnia…rather issues like anxiety, stress and depression and other emotional and psychological factors are more likely interfering with their sleep. Rather than complain of daytime sleepiness, females are more likely to say they are unable to fall asleep and stay asleep at night and are more likely to be depressed, McCall says.”
“Obstructive sleep apnea may be one reason depression treatment doesn’t work.” Mental Health Weekly Digest, 5 Aug. 2019, p. 320. COPYRIGHT 2019 NewsRX LLC
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The Correlation of Anxiety and Depression
With Obstructive Sleep Apnea Syndrome
Authors: Fariborz Rezaeitalab , Fatemeh Moharrari , Soheila Saberi, Hadi Asadpour, Fariba Rezaeetalab
Publisher: J Res Med Sci. 2014 Mar;19(3):205-10.
Background: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated upper airway obstruction during sleep. While respiratory pauses followed by loud snoring and daytime sleepiness are the main symptoms of OSAS, the patients may complain from sleep disruption, headache, mood disturbance, irritability, and memory impairment. However, the association of sleep apnea with anxiety and depression is not completely understood. Adherence to continuous positive airway pressure (CPAP), the treatment of choice for OSAS, may be influenced by psychological conditions, especially claustrophobia. The aim of this study was to evaluate the association of OSAS with anxiety and depression symptoms. This study also investigated the association of anxiety with body mass index (BMI) and the severity of OSAS.
Materials and methods: We conducted a cross-sectional study on 178 adult individuals diagnosed with OSAS at the sleep laboratory between September 2008 and May 2012. The participants were interviewed according to a checklist regarding both their chief complaints and other associated symptoms. The psychological status was assessed according to Beck anxiety inventory (BAI) and Beck depression inventory (BDI) scoring. The severity of breathing disorder was classified as mild, moderate, and severe based on apnea-hypopnea index (AHI) which was ascertained by overnight polysomnography. Daytime sleepiness was assessed by Epworth sleepiness scale (ESS).
Results: The mean (SD) age of participants was 50.33 years. In terms of sex, 85.5% of the study population were males and 14.4% were females. We found no relation between sex and the symptoms of OSAS. Regarding the frequency of anxiety and depression symptoms, 53.9% of the individuals had some degree of anxiety, while 46.1% demonstrated depressive symptoms. In terms of OSAS severity, this study showed that OSAS severity was associated with the frequency of anxiety, choking, and sleepiness (P : 0.001). According to polysomnographic results, we found that the majority of patients suffering from anxiety and choking (66.7% and 71.4%, respectively) had severe OSAS, while only 23.1% of patients with sleepiness had severe OSAS.
Conclusion: Our study showed that the frequency of anxiety in OSAS patients is higher than in the general population regardless of the gender. Furthermore, it is more likely that OSAS patients present with anxiety and depression than the typical symptoms.
Rezaeitalab F, Moharrari F, Saberi S, Asadpour H, Rezaeetalab F. The correlation of anxiety and depression with obstructive sleep apnea syndrome. J Res Med Sci. 2014;19(3):205‐210.