What is bronchiectasis?
Bronchiectasis is a lung condition that causes coughing up of mucus. It is (pronounced brong-kee-ek-tuh-sis). In the lungs, the bronchi are the passages that allow air to enter the lungs. In bronchiectasis, the inside surfaces of the bronchi get thicker over time from inflammation that leave scars. Thicker walls cause mucus to collect in these passages because the walls are not strong enough to make the mucus move out of the lungs. In addition, the cilia (thin strands that look like hair and that help move mucus) are destroyed. When that happens, infections can happen more easily and breathing becomes difficult. Times that breathing or coughing gets worse are called exacerbations.
How common is bronchiectasis?
It is estimated that there are 500,000 individuals in the United States with bronchiectasis and one person out of 150 people aged 75 years old and older has bronchiectasis. The risk of getting this condition increases with age. However, younger people can and do get bronchiectasis. In adults, it is much more common in women than in men. In children, it is more common in boys than girls. It is possible, but rare, for children to be born with bronchiectasis.
What are risk factors for bronchiectasis?
People with the following conditions are considered to have risk factors for bronchiectasis:
- Cystic fibrosis
- Chronic and inflammatory lung disease
- Chronic or severe lung infections, like tuberculosis, non-tuberculous mycobacteria (NTM) or pneumonia
- Deficits in the immune system
- Repeated aspiration (breathing in) of things other than air, such as food particles, that cause damage to the lungs
Symptoms and Causes
What causes bronchiectasis?
Bronchiectasis may be caused by cystic fibrosis (CF), a genetic condition that results in long-lasting lung infections and reduced ability to breathe. CF gets worse over time.
For non-CF bronchiectasis, the cause is not always known. This is called idiopathic bronchiectasis. However, in other cases, causes include:
- Past severe infection that has damaged the lung
- Genetic diseases like primary ciliary dyskinesia or alpha-1 antitrypsin deficiency
- Immune system conditions that make it difficult to fight off infections
- Aspirating (breathing in) things like fluids, stomach acid, or foods into the lungs
- Allergic bronchopulmonary aspergillosis, an allergy to a particular type of fungus
- Other conditions like rheumatoid arthritis, Crohn’s disease, and Sjogren’s syndrome
- Obstructed airways (airways blocked by something like a tumor or an inhaled object)
What are the symptoms of bronchiectasis?
Some of the most common symptoms are:
- Coughing that results in a lot of mucus
- Coughing up mucus that has blood in it (known as hemoptysis)
- Chest pain or tightness because it is harder to breathe
- Wheezing or making whistling noises when breathing
- Clubbing of nails
- Loss of weight
- Flare-ups that usually include:
- Fevers and/or chills
- Increased shortness of breath
- Night sweats
Diagnosis and Tests
How will a doctor diagnose bronchiectasis?
Bronchiectasis is believed to be underdiagnosed. If your symptoms lead your doctor to suspect this disease, the following tests are likely to be ordered:
- Chest CT scan or X-ray, imaging tests to show the state of the lungs.
- Blood tests and sputum cultures to find out if there are infections.
- Lung function tests to determine how well you are breathing/how well your lungs are working.
- Bronchoscopy, which is a way to see inside the lungs. The method uses a light and a camera on a tube inserted through the nose or mouth and then down the trachea into the lungs. In the case of blockages, a bronchoscopy can also find and remove the object blocking the airways. The procedure can also be used to obtain lung secretions.
Management and Treatment
What are the treatments for bronchiectasis?
Bronchiectasis cannot be cured, but it can be managed. Your doctor might prescribe medication, the use of certain devices, or a combination of these methods and possibly others.
If bronchiectasis is caused by an underlying condition, like aspergillosis or an immune system disease, then that condition must be treated first.
Treatment choices might include medications, such as:
- Antibiotics, drugs used to treat bacterial infections. These include oral (pill) forms and inhaled forms (breathed in using a nebulizer machine).
- Macrolides, drugs used to treat infections and inflammations at the same time.
- Drugs that affect mucus and help you cough the mucus out.
Treatment might also include:
- Airway clearance devices to break up mucus and help you cough it out
- Positive expiratory pressure (PEP) devices that you can hold in your hands
- Percussive devices like vests you can wear
- Physical therapy moves like chest clapping to help move mucus out of the body
In addition, bronchiectasis treatment is broken down further by what stage you are in: there are things that you do daily (maintenance) and things that you do when you are having an exacerbation (worsening).
How can you prevent bronchiectasis?
There is no way to prevent congenital bronchiectasis (the kind you are born with). However, there are ways to help you avoid developing the lung damage that leads to bronchiectasis.
- Make sure you vaccinate your children against diseases such as measles and whooping cough.
- If you or your child develop any kind of lung infection, get medical treatment.
- Be aware of the risks of breathing in any object. If your child or any adult breathes in an object, get immediate medical help.
- Stay away from airborne substances that can hurt your lungs like smoke, fumes and gases.
Outlook / Prognosis
What is the prognosis/outlook for patients who have bronchiectasis?
The outlook for people with bronchiectasis is better now than it used to be. People who are treated live relatively normal lifespans. The outlook is also based on the person’s age, general health, how many exacerbations happen during a specified period of time, and how bad the exacerbations are.
What are some tips for living well with bronchiectasis?
- Do not smoke. If you do smoke, ask your doctor for help in stopping.
- It is important to follow the daily maintenance therapy that your doctor recommends.
- Eat a healthy diet.
- Drink plenty of water to stay hydrated and to keep mucus from getting sticky.
- Follow a regular exercise routine.
- Make sure you get a flu shot every year and the pneumonia vaccine as directed by your doctor.
When should I see a healthcare provider about bronchiectasis?
If at any time you find yourself coughing a lot, coughing up mucus frequently, coughing up blood, or having trouble breathing, you should consult a healthcare provider.
If you have been diagnosed with bronchiectasis, you should contact your healthcare provider if:
- You have signs of infection, like a fever or chills
- You have more trouble breathing than usual
- You have pain in your chest
- You are much more tired than usual
- You are losing weight unintentionally
- You are coughing up more mucus, mucus with blood in it, or mucus that is yellow or green
- You do not have an appetite
Are there organizations that support people who have bronchiectasis and their caregivers?
You might find the following organizations to be helpful:
- American Lung Association’s Living with Lung Disease Community
- Bronchiectasis and NTM Initiative
- Cystic Fibrosis Foundation