Bronchiectasis happens when irreversible damage affects the bronchi, which are part of the respiratory system. A person will have a persistent cough and frequent infections, and they will have difficulty removing sputum.
Bronchiectasis can happen when a medical condition or an infection damages the lungs, leaving them unable to remove mucus. As mucus collects in the lungs, there is a risk of further infections and more damage.
It can occur at any age, but it is most common among women aged over 60 years.
In the past, bronchiectasis often affected children. However, progress in hygiene standards, antibiotics, and immunization programs have made the childhood infections that cause it less common. By the 1980s, it appeared to be on the decline.
However, there are now concerns that it is reappearing.
Between 2009 and 2013, bronchiectasis affected 213 people in every 100,000, and 340,000–522,000 adults received treatment. Since 2001, the number of diagnoses has increased by around 8 percent each year.
Bronchiectasis is a serious condition. Without treatment, it can lead to respiratory failure or heart failure. Early diagnosis and treatment, however, can help people to manage the symptoms and prevent the condition from worsening.
Bronchiectasis develops because of damage to the airways. It may take months or years for the signs and symptoms to appear.
The most common symptoms
- a persistent, daily cough
- production of sputum
- chest pain or discomfort
- wheezing and shortness of breath
- thickening of the skin under the fingernails and toenails, and nails that may curve downward
- tiredness and fatigue
The lungs will crackle when a doctor listens to them through a stethoscope.
The person may also have repeated chest infections. Doctors consider these an exacerbation. Each infection can cause the long-term symptoms to worsen.
Later signs and symptoms may include:
- difficulty walking more than 100 meters without stopping
- frequent or severe chest infections
- a pale or blue skin color
- weight loss
- slow growth in children
- blood in the mucus
- coughing up blood
- a smell on the breath
Tests may show:
- fungus on sputum
- widespread damage to the lungs
Patients with severe bronchiectasis may eventually develop more serious conditions, such as a collapsed lung and respiratory failure. Low oxygen levels can lead to heart failure.
When we breathe, air enters and leaves the lungs through a series of branching airways called bronchial tubes. Normally, these tubes narrow smoothly towards the edges of each lung.
The damage caused in bronchiectasis means that they widen instead of narrowing.
Cilia and mucus cover the linings of the bronchial tubes. Mucus protects against unwanted particles that enter the lungs. Cilia are like tiny hairs that sweep the particles and excess mucus upwards, out of the lung.
This is an ongoing process, although most people do not notice the mucus coming out, except, for example, during a seasonal cold.
In bronchiectasis, damage to the cilia in the bronchial tubes means they cannot sweep the particles and mucus upward. Instead, particles and mucus accumulate. The sputum becomes sticky and difficult to move, even with coughing.
As the sputum collects, bacteria also gather and start to multiply, leading to Infections, further damage, and more sputum.
The exact cause of bronchiectasis is unclear. However, damage to the bronchial tubes may occur during an infection or a medical condition.
Cystic fibrosis (CF) accounts for almost half of the cases in the United States.
CF is a
Non-CF bronchiectasis refers to bronchiectasis that is not due to CF.
Infections that increase the risk
- tuberculosis (TB)
- a fungal infection
- whooping cough early in life
A wide variety of factors can lead to bronchiectasis, including:
- genetic abnormalities
- immunologic conditions
- autoimmune diseases, such as rheumatoid arthritis
- airway obstruction
- underlying deficiencies due to genetic factors
Other health conditions
Apart from CF, a number of other long-term conditions can increase the risk of bronchiectasis.
Chronic obstructive pulmonary disease (COPD): This is a long-term condition that involves inflammation and damage to lung tissue and a narrowing of the airways. This can make breathing difficult.
Antitrypsin (A1AT) deficiency: This is a genetic condition that can lead to lung and liver problems. It can involve gastroesophageal reflux, micro-aspiration, and difficulty swallowing.
Young’s syndrome: A person produces mucus that is unusually viscous.
Allergic bronchopulmonary aspergillosis (ABPA): Some people have an allergy to aspergillus, a type of fungus. Exposure to the fungus can lead to inflammation and swelling of the airways and the lungs.
Asthma: Severe asthma, especially if a person also has aspergillosis, can increase the risk.
Primary ciliary dyskinesia (PCD), or Kartagener Syndrome (KS): This is an inherited condition in which the cilia in the airway do not work properly. They cannot sweep out secretions effectively. This can lead to recurrent infections.
Immunodeficiency disorders: These include common variable immunodeficiency, HIV, and AIDs.
Chronic pulmonary aspiration: A person with this condition inhales food, saliva, and other unwanted substances into the lungs. It may be due to alpha-1 antitrypsin deficiency.
Connective tissue diseases: These are auto-immune diseases that include Crohn’s disease and Sjögren’s syndrome.
Environmental factors and blockages
Blockages: If bronchiectasis affects only one part of the lung, this may be a sign of a blockage, possibly due to a noncancerous growth or an inhaled object, such as a peanut.
Inhaling toxins: Breathing in ammonia and other toxic gases or liquids may also lead to bronchiectasis.
Any problem with the airways or lungs needs medical attention.
A doctor will consider the symptoms and carry out a physical examination.
They may recommend the following tests:
- a chest X-ray
- a high resolution computed tomography (HRCT) scan
- spirometry, which measures lung function
- laboratory tests on sputum samples
- blood tests, to assess overall health
They may also test for cystic fibrosis if the person could be at risk.
A person with bronchiectasis may need ongoing monitoring, to check for infections or a worsening of the condition.
There is no cure for bronchiectasis, but early and effective treatment can help to:
- reduce complications
- prevent infections and exacerbations
- control secretions
- relieve obstructions in the airway
- improve quality of life
- stop the disease from progressing
To treat an infection, a doctor may prescribe:
- antibiotics, either for an infection or ongoing, to prevent new infections
- bronchodilators, usually for breathing in, to relax the muscles in the airway
- physical therapy and exercise, to help clear secretions
- mucoactive drugs, to help clear mucus
- good hydration, for example, through drinking enough fluid, to reduce the chance of mucus becoming thick and sticky
People with an underlying condition may receive treatment for that condition, and this may reduce the symptoms and progression of bronchiectasis.
In severe cases, oxygen therapy may be necessary to raise blood oxygen levels.
Treating inflammation and mucus accumulation
Doctors sometimes prescribe inhaled corticosteroids to reduce inflammation, but researchers say there is little evidence to show that it helps.
Some physical strategies can help to drain the mucus.
Postural drainage: Sitting or lying in certain positions will allow gravity to help clear congestion.
Chest percussion: A therapist will tap the chest with hollowed hands or a percussion device to loosen the mucus so that the patient can cough it up. Other names for this are chest physical therapy (CPT) or chest clapping.
Devices: Some devices may help to loosen mucus in the lungs, such as an electric chest clapper, an inflatable therapy vest that uses high-frequency air-waves, or a small, handheld device that causes vibrations.
Exercises to strengthen the chest muscles may help a person to breathe more easily. Physical activity in general will also help.
Removing a bronchial obstruction
If a small item has become lodged in the airway, a doctor will remove it.
They may use a bronchoscope, a long, thin, flexible tube with a light and camera at the end, to see the inside of the airway and remove an obstruction, if necessary.
Lung surgery and embolization
If bronchiectasis affects only one lung or a limited area, or if damage is severe and there are frequent infections, surgery may be appropriate.
Sometimes, a person with advanced bronchiectasis and cystic fibrosis may need lung transplantation.
Complications of bronchiectasis include:
- repeat infections
- bleeding in the lungs
- respiratory failure, leading to low oxygen levels
- atelectasis, or a collapsed lung, which makes it difficult to breathe
- heart failure due to low oxygen levels
Some of these can be life-threatening. If any changes occur in a person with bronchiectasis, they should see a doctor.
Having routine vaccinations against certain diseases can reduce the risk of the type of damage that leads to bronchiectasis.
- measles, whooping cough, and pneumonia for children
- influenza and pneumococcus for people of any age who may be at risk
Other steps to reduce the risk
- avoiding toxic fumes
- getting early treatment for other lung problems, such as asthma or COPD
- monitoring children to reduce the risk of them inhaling toys and other small items
Smoking can worsen any lung condition. People with bronchiectasis should avoid smoking or quit if they already smoke. A doctor can advise on how to do this.
Early diagnosis and treatment are essential, especially for children.
The outlook depends on several factors but mainly on how well treatment can manage or prevent infections and possible complications.
The prognosis can be worse if a person:
- delays treatment
- has co-existing conditions, such as chronic bronchitis or emphysema
- has complications, such as pulmonary hypertension
The NHLBI note that, with proper treatment, a person with bronchiectasis can enjoy a good quality of life.
The important thing is to seek treatment as soon as symptoms appear and whenever they worsen.
Can smoking or traffic pollution cause bronchiectasis?
Several research articles published in recent years have found that while irritants like smoking or traffic pollution do not cause bronchiectasis, they can make the condition and symptoms much worse.
Smoking and traffic pollution are risk factors for COPD. With COPD, there is a narrowing of the bronchial tubes which allows mucus to build up and impair respiratory function.
Individuals who have had COPD for a long time may develop bronchiectasis.