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Bronchiectasis

What is bronchiectasis?

Bronchiectasis is a condition where the bronchial tubes of your lungs are permanently damaged, widened, and thickened. These damaged air passages allow bacteria and mucus to build up and pool in your lungs. This results in frequent infections and blockages of the airways.

There is no cure for bronchiectasis, but it is manageable. With treatment, you can typically live a normal life. However, flare-ups must be treated quickly to maintain oxygen flow to the rest of your body and prevent further lung damage.

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Causes

What are the causes of bronchiectasis?

Any lung injury can cause bronchiectasis. There are two main categories of this condition. One is related to having cystic fibrosis (CF), and is known as CF bronchiectasis. CF is a genetic condition that causes an abnormal production of mucus.

The other category is non-CF bronchiectasis, which isn’t related to CF. The most common known conditions that can lead to non-CF bronchiectasis include:

Cystic fibrosis causes about one-third of all cases of bronchiectasis. CF affects the lungs and other organs like the pancreas and liver. In the lungs, this results in repeated infections. In other organs, it causes poor functioning.

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Symptoms

What are the symptoms of bronchiectasis?

Symptoms of bronchiectasis can take months or even years to develop. Some typical symptoms include:

  • chronic daily cough
  • coughing up blood
  • abnormal sounds or wheezing in the chest with breathing
  • shortness of breath
  • chest pain
  • coughing up large amounts of thick mucus every day
  • weight loss
  • fatigue
  • thickening of the skin under your nails and toes, known as clubbing
  • frequent respiratory infections

If you’re experiencing any of these symptoms, you should see your doctor immediately for diagnosis and treatment.

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Diagnosis

How is bronchiectasis diagnosed?

Your doctor will listen to your lungs to check for any abnormal sounds or evidence of airway blockage. You’ll likely need a complete blood test to look for infection and anemia. Other tests may include:

  • sputum test to check your mucus for microorganisms such as viruses, fungus, or bacteria
  • chest X-ray or CT scan to provide images of your lungs
  • pulmonary function tests to find out how well air is flowing into your lungs
  • QuantiFERON blood test or purified protein derivative (PPD) skin test to check for tuberculosis
  • sweat test to screen for CF
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Treatment

Treatment options for bronchiectasis

There’s no cure for bronchiectasis, but treatment is important to help you manage the condition. The main goal of treatment is to keep infections and bronchial secretions under control. It’s also critical to prevent further obstructions of the airways and minimize lung damage. Common methods of treating bronchiectasis include:

  • methods for clearing the airways (like breathing exercises and chest physiotherapy)
  • pulmonary rehabilitation
  • antibiotics to prevent and treat infection — studies are currently being done on new formulations of inhaled antibiotics
  • bronchodilators like albuterol (Proventil) and tiotropium (Spiriva) to open up airways
  • medications to thin mucus
  • expectorants to aid in coughing up mucus
  • oxygen therapy
  • vaccinations to prevent respiratory infections

You may need the help of chest physiotherapy. One form is a high-frequency chest wall oscillation vest to help clear your lungs of mucus. The vest gently compresses and releases your chest, creating the same effect as a cough. This dislodges mucus from the walls of the bronchial tubes.

If there’s bleeding in the lung, or if the bronchiectasis is only in one part of your lung, you may need surgery to remove the affected area.

Another part of daily treatment involves draining of the bronchial secretions, aided by gravity. A respiratory therapist can teach you techniques to aid in coughing up the excess mucus.

If conditions like immune disorders or COPD are causing your bronchiectasis, your doctor also will treat those conditions.

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Prevention

Can bronchiectasis be prevented?

The exact cause of bronchiectasis is unknown in about 50 percent of the cases of non-CF bronchiectasis. In up to 35 percent of people, it may occur after a lung infection. For others, it’s related to genetic abnormalities that affect the lungs and other medical conditions. Avoiding smoking, polluted air, cooking fumes, and chemicals can help protect your lungs and maintain lung health.

You and your children should be vaccinated against the flu, pertussis, and measles, as these conditions have been linked to the condition in adulthood. But often when the cause is unknown, prevention is difficult. Early recognition of bronchiectasis is important so that intervention can begin before significant lung damage occurs.

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