Bronchiectasis

Bronchiectasis is a lung condition where your airways get damaged and enlarged. Your airways are the tubes that carry air into your lungs.

Damaged airways can’t clear mucus like they’re supposed to. Bacteria then grow in the mucus, causing more inflammation and damage to your lungs. This makes you cough a lot as your body tries to remove the infected mucus.

Bronchiectasis (“bronk-ee-EK-tuh-sis”) can be mild or severe depending on how damaged your lungs are. Some people have it and don’t even know it. Others have long-lasting symptoms, repeated infections and severe airway damage.

Types

Healthcare providers describe bronchiectasis based on what the damage looks like and how widespread it is. Types include:

• Cylindrical: This describes airways that are enlarged evenly and uniformly, like a smooth cylinder. There aren’t any pouches. This is the most common and least serious form.
• Varicose: This describes areas of your airways that are wider in some places and narrower in others. On imaging, it looks similar to varicose veins.
• Cystic: This type causes honeycomb-like pockets of fluid (cysts) in your airways. This is the most severe form.
• Traction: This is when scarring widens your airways and pulls them out of shape.
• Focal: This means the damage is limited to one area of your lungs.
• Diffuse: This means the damage affects many areas throughout your lungs.

Symptoms of bronchiectasis

Bronchiectasis symptoms include:

• Cough with lots of mucus and pus
• Repeated colds
• Bad-smelling mucus
• Shortness of breath
• Wheezing
• Coughing up blood

You might have stretches of time where your symptoms aren’t as bad, then have a flare-up (exacerbation) where your symptoms get worse. Exacerbation symptoms include:

• Extreme tiredness (fatigue)
• Fever, chills
• Increased shortness of breath
• Night sweats

Bronchiectasis causes

Airway damage causes bronchiectasis. Mucus in your airways is one way your body protects you from germs. Certain conditions make it so you can’t cough out mucus — and the bacteria trapped in it. This can cause lasting damage to your airways.

This damage happens in two phases:

• First phase (“insult”): This is the initial damage. It’s caused by a bacterial infection, inflammatory disorder or another condition that affects your lungs. Healthcare providers don’t always know the initial cause of the damage.
• Second phase (“vicious vortex”): The initial damage makes you more likely to get inflammation and repeated infections. This cycle causes further damage to your lungs.

What diseases cause bronchiectasis?

Some of the specific causes of initial damage that start the cycle of bronchiectasis include:

• Cystic fibrosis
• Mycobacterial infections, like MAC infections or tuberculosis
• Autoimmune or inflammatory disorders
• Foreign bodies, tumors or lymph nodes that block airways and prevent mucus clearance
• Conditions that weaken your immune system and increase risk of infections (like HIV, receiving an organ transplant and primary immunodeficiencies)
• Primary ciliary dyskinesia
• Allergic bronchopulmonary aspergillosis (ABPA), an allergy to a type of fungus
• Fibrosis (scarring) from radiation
• Alpha-1 antitrypsin deficiency

It’s also associated with other pulmonary disorders, like asthma and COPD (chronic obstructive pulmonary disease).

Risk factors

In general, the risk of bronchiectasis increases as you get older. You’re also at a higher risk if you have an underlying condition that affects your lungs or immune system.

Complications

Damage caused by severe bronchiectasis can lead to life-threatening complications. These include:

• Respiratory failure: If your lungs aren’t working properly, you might not be able to get enough oxygen to your blood and tissues.
• Severe bleeding: Blood vessels in your airways may get so damaged that they bleed heavily. You may cough up blood if this happens.
• Antibiotic-resistant infections: You may get infections that are hard to treat.

How doctors diagnose bronchiectasis

Healthcare providers diagnose bronchiectasis by listening to your lungs and testing how well they’re working. If they think you have bronchiectasis or another lung condition, they’ll recommend imaging tests to take a closer look at your lungs.

Tests

A healthcare provider may do tests to diagnose bronchiectasis or rule out other conditions. These could include:

• Chest X-ray or CT scan: A machine takes pictures of your lungs to look for damage.
• Blood tests and sputum cultures: A provider takes samples of your blood or mucus (sputum) to look for infections.
• Lung function tests: These help your provider determine how well your lungs are working.
• Genetic testing: A provider may test samples of your blood or other body fluids for genetic conditions.
• Sweat chloride test: If a provider thinks you could have cystic fibrosis, they’ll do a sweat test. They’ll make your arm or leg sweat, collect a sample and test it for signs of cystic fibrosis.
• Bronchoscopy: In some cases, a provider may use a bronchoscope (a long, flexible tube with a light and camera at the end) to find and remove anything blocking your airways. They’ll take samples of mucus or pus from your lungs for testing.

How is bronchiectasis treated?

Healthcare providers treat bronchiectasis by clearing mucus and managing infections. Treatment options could include:

• Antibiotics: Antibiotics can treat infections from bacteria. You might take them as a pill, get them in an IV (through a vein) or use an inhaler that contains antibiotics.
• Macrolides: Macrolides are drugs that treat infections and inflammation at the same time.
• Expectorants and mucolytics: These are medications that thin mucus and help you cough it out.
• Chest physical therapy: Postural draining and chest percussion therapy can help loosen and remove mucus. Breathing exercises can help open up your airways.
• Medical devices: Oscillating positive expiratory pressure (PEP) devices and percussive vests break up and pull mucus out of your lungs.
• Surgery: If you have a small area of bronchiectasis, your provider might recommend surgery. This is rare.

If an underlying medical condition is causing bronchiectasis, treating that condition may help your symptoms.

When should I see my healthcare provider?

If you have bronchiectasis, contact your healthcare provider if you:

• Have signs of infection, like a fever or chills
• Have more trouble breathing than usual
• Are much more tired than usual
• Are losing weight unintentionally
• Are coughing up more mucus, bloody mucus, or yellow or green mucus
• Don’t have an appetite

When should I go to the ER?

Go to the ER if you are:

• Coughing up a lot of blood
• Having chest pains
• Struggling to breathe

What can I expect if I have bronchiectasis?

Bronchiectasis can’t be cured — the damage it causes is irreversible. But most people can manage the symptoms by working together with their healthcare providers.

Your outlook will depend on how severe your condition is, how well you respond to treatment and what other health conditions you have. You may need to practice physical therapies or take medications daily. More severe cases may impact your quality of life.

Can bronchiectasis be prevented?

You can reduce your risk of developing bronchiectasis by taking steps to protect your lung health:

• Check with your healthcare provider to see what vaccinations they recommend for you and your family. Pertussis, the flu, pneumococcal disease and measles can all cause or worsen bronchiectasis.
• Work with your healthcare provider to treat any ongoing health conditions, especially those that affect your lungs. Talk to your provider if you feel like medications or therapies aren’t working.
• Avoid breathing in things that can hurt your lungs, like cigarette smoke, vaping, fumes and gases. Wear a respirator mask and work in a well-ventilated area if you’re around dust or fumes.

What’s the difference between bronchiectasis and bronchitis?

Bronchiectasis and bronchitis have similar symptoms, including mucus in your lungs and coughing. But bronchiectasis causes permanent widening of your airways. Bronchitis is a temporary infection that doesn’t cause lasting damage.