Craig Steinmaus, MD, MPH and Allan H. Smith, MD, Ph.D.
Background: Bronchiectasis is a relatively rare condition that affects the lungs. In this disorder the bronchial tubes become enlarged and distended forming pockets where infection may gather. The bronchial tube walls are damaged which results in impairment to the lung’s complex cleaning system. Cilia, which line the bronchial tubes and sweep them free of dust, germs and excess mucus, are destroyed. When this cleaning system is not working effectively dust, mucus and bacteria accumulate resulting in a difficult to treat infection.
Bronchiectasis is caused by various types of infections which damage and weaken the bronchial walls and interfere with the action of the cilia. Patients may be predisposed to get this condition with various congenital or inherited deficiencies such as immunological deficiency or cystic fibrosis. More recent research has postulated that certain environmental exposures, including arsenic contaminated drinking water may also cause bronchiectasis.
Advance: In an NIEHS-sponsored study of people exposed to arsenic through contaminated drinking water in West Bengal, India, more evidence has been gathered that arsenic may cause bronchiectasis. Thirty-eight people in the study reported chronic cough and underwent computed tomography scans. Brochiectasis severity was almost 4 times worse in 27 participants with skin lesions, a common sign of arsenic exposure, than in the 11 subjects without skin lesions. Overall, subjects with arsenic-related skin lesions were 10 times more likely to have bronchiectasis than those without lesions.
Implications: These results add to the growing evidence that arsenic causes not only lung cancer, but non-malignant lung disease as well. The authors conclude that future research on risk of arsenic-induced lung disease in susceptible populations, such as children or the elderly, may be useful in evaluating the safety of current arsenic drinking water standards.
Citation: Mazumder DN, Steinmaus C, Bhattacharya P, von Ehrenstein OS, Ghosh N, Gotway M, Sil A, Balmes JR, Haque R, Hira-Smith MM, Smith AH. Bronchiectasis in persons with skin lesions resulting from arsenic in drinking water. Epidemiology. 2005 Nov;16(6):760-5.