Bronchiectasis

What is bronchiectasis?

Bronchiectasis is a lung condition which causes damage to the airways and results in a persistent cough. Bronchiectasis occurs when the cilia (tiny hair-like structures responsible for removing mucus and keeping the lungs clear) are destroyed. This then contributes to a build-up of mucus and bacteria, which causes sputum to collect. Sputum (also known as phlegm) can be very sticky, thick and hard to dislodge from the lungs. Bronchiectasis causes the bronchiole tubes (also known as the bronchi), which are the small tubes that air passes in and out of, to become damaged and widen instead of narrowing. Bronchiectasis prevents the bronchi from cleaning themselves and this increases the risk of bacterial infection.

What causes bronchiectasis?

In around half of the cases of bronchiectasis the cause is unknown and the other half are usually associated with underlying health conditions. Some lung conditions cause an abnormal inflammatory response, which increases the risk of the bronchioles becoming widened and therefore increases the risk of developing bronchiectasis. Health conditions which may cause bronchiectasis include:

• Cystic fibrosis.
• Primary cilia dyskinesia.
• An abnormality in the immune system.

Other possible causes include:

• Inhaling toxic gases.
• Acid being regurgitated from the stomach into the lungs.
• Inhaling a foreign body.
• Allergy to fungal spores.
• Blockage caused by scarring.
• Severe infections, such as pneumonia, measles and whooping cough.

How is bronchiectasis diagnosed?

If your doctor suspects that you have bronchiectasis, they will carry out a series of tests, including:

• CT scan.
• Blood tests.
• Sweat test: this is to see how much salt is present in the sweat.
• Pathology tests may be carried out to determine what kinds of bacteria are present in the sputum.

The results of all the tests will be used to confirm a diagnosis.

What are the symptoms of bronchiectasis?

The main symptoms of bronchiectasis include:

• A persistent cough.
• Coughing up large amounts of phlegm: this can cause people to feel embarrassed, especially if they are around other people.
• Frequent chest infections: bronchiectasis increases the risk of chest infections because the build-up of mucus attracts bacteria, which cause infections.
• Feeling tired and generally unwell.
• Loss of appetite and subsequent weight loss.
• Breathing difficulties.
• A runny nose.
• Chronic infection of the sinuses in the nose.

Less common symptoms include:

• Coughing up blood.
• Joint aches and pains.
• Chest pain.

Possible complications of bronchiectasis include:

• Spread of infection to other parts of the body.
• Coughing up blood.
• A lung abscess (this is very rare).

Treatment for bronchiectasis

There is currently no cure for bronchiectasis; however, there are treatments that can help to ease symptoms. The main treatment is medication, which helps to prevent further damage to the lungs and prevent infections caused by bacteria collecting in the bronchioles. Medication usually involves antibiotics and corticosteroids, also antibiotics can be taken in tablet form, inhaled or injected. Other treatments or therapies may be used to try and control symptoms. These include:

• Chest physiotherapy: this helps to dislodge the sputum and make it easier to breathe and prevent bacterial infection. Physiotherapy helps to strengthen the chest muscles to make breathing easier.
• Exercise: exercising on a daily basis (this should involve fairly gentle exercise, such as swimming) will help to clear the lungs of mucus.
• Breathing exercises.
• Asthma treatment.
• Nasal sprays to reduce congestion.
• Postural drainage to loosen the mucus.
• Salt solutions: this makes the mucus less sticky and helps to prevent mucus from building up.

If all other treatments fail, surgery may be carried out. Surgery usually involves removing the damaged part of the lungs but if damage is extensive, a lung transplant may be required.

What is the outlook for bronchiectasis?

Historically, bronchiectasis develops in childhood but this is becoming increasingly rare, thanks to childhood immunisations and antibiotics – now most cases affect older people. There is currently no cure for bronchiectasis and damage to the lungs is permanent. However, if the condition is detected early and managed effectively, further damage could be prevented.