Bronchiectasis is a condition that occurs when the tubes that carry air in and out of your lungs get damaged, causing them to widen and become loose and scarred. These tubes are called airways.
Bronchiectasis usually results from an infection or other condition that injures the walls of your airways or prevents the airways themselves from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles.
In bronchiectasis, your airways slowly lose their ability to clear out this mucus. When mucus can’t be cleared, it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections.
Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can make it hard for enough oxygen to reach your vital organs.
Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs. It can lead to serious health problems, such as respiratory failure, a collapsed lung, and heart failure. Currently, bronchiectasis has no cure. However, with proper care, most people who have it can enjoy a good quality of life.
Early diagnosis and treatment of bronchiectasis is important. The sooner your doctor starts treating bronchiectasis and any underlying conditions, the better your chances of preventing further lung damage.
How do you get it?
Bronchiectasis can be congenitalor acquired.
- Congenital bronchiectasis affects infants and children. It’s the result of a problem with how the lungs form in a fetus.
- Acquired bronchiectasis occurs as a result of another condition or factor. This type of bronchiectasis can affect adults and older children. Acquired bronchiectasis is more common than the congenital type.
Damage to the walls of the airways – for example, from a lung infection – usually causes acquired bronchiectasis. Examples of lung infections that can lead to bronchiectasis include:
- Severe pneumonia
- Whooping cough or measles (uncommon in the United States due to vaccination)
- Fungal infections
Other conditions, such as an airway blockage, also can lead to bronchiectasis. Many things can cause a blockage, such as a growth or a noncancerous tumor. An inhaled object, such as a piece of a toy or a peanut that you inhaled as a child, also can cause an airway blockage.
What raises your risk?
People who have conditions that damage the lungs or increase the risk of lung infections are at risk of bronchiectasis. Examples of such conditions include:
- Cystic fibrosis, which causes almost half of the cases of bronchiectasis in the United States
- Immunodeficiency disorders, such as common variable immunodeficiency and, less often, HIV and AIDS
- Allergic bronchopulmonary aspergillosis, which is an allergic reaction to a fungus called aspergillus that causes swelling in the airways
- Disorders that affect cilia function, such as primary ciliary dyskinesia, can cause bronchiectasis. Cilia are small, hair-like structures that line your airways. They help clear mucus (a slimy substance) out of your airways.
- Chronic (long-term) pulmonary aspiration, which can inflame the airways
- Connective tissue diseases, such as rheumatoid arthritis, Sjögren’s syndrome, and Crohn’s disease
The initial airway damage that leads to bronchiectasis often begins in childhood. However, symptoms may not appear until months or even years after you start having repeated lung infections.
The most common symptoms of bronchiectasis are:
- A daily cough that occurs over months or years
- Daily production of large amounts of sputum (spit), which you cough up and which may have mucus, trapped particles, and pus
- Shortness of breath and wheezing (a whistling sound when you breathe)
- Chest pain
- Clubbing (the flesh under your fingernails and toenails gets thicker, causing the nails to curve downward)
If your doctor listens to your lungs with a stethoscope, he or she may hear abnormal lung sounds.
Over time, you may have more serious symptoms. You may cough up blood or bloody mucus and feel very tired. Children may lose weight or not grow at a normal rate
How will my doctor find out if I have bronchiectasis?
Chest CT scan: A chest computed tomography (CT) scan is a painless imaging test that takes many detailed pictures, called slices, of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models that show the size, shape, and position of your lungs and structures in your chest.
A chest CT scan can help figure out the cause of lung symptoms such as shortness of breath or chest pain. It can also tell your doctor if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, or pneumonia. Your chest CT scan may be done in a medical imaging facility or hospital. You will lie still on a table and the table will slide into the scanner. You will hear soft buzzing or clicking sounds when you are inside the scanner and the scanner is taking pictures. You will be able to hear from and talk to the technician performing the test while you are inside the scanner. For some diagnoses, a contrast dye, often iodine-based, may be injected into a vein in your arm before the imaging test. In rare instances, some people have an allergic reaction to contrast dye. There is also a slight risk of cancer, particularly in growing children, because the test uses radiation. Although the amount of radiation from one test is usually less than the amount of radiation you are naturally exposed to over three years, patients should not receive more CT scans than what is recommended by clinical guidelines recommend.
Chest X-ray: A chest X-ray is a fast and painless imaging test to look at the structures in and around your chest. This test can help diagnose and check conditions such as pneumonia, heart failure, lung cancer, tuberculosis, sarcoidosis, and lung tissue scarring, called fibrosis. Doctors may use chest X-rays to see how well certain treatments are working and to check for complications after certain procedures or surgeries. The test may be done in the doctor’s office, clinic, or hospital. You will stand, sit, or lie still for the test. Chest X-rays have few risks. The amount of radiation used in a chest X-ray is very small. Talk to your provider if you are or could be pregnant.
Your doctor may recommend other tests.
- Blood tests can show whether you have an underlying condition that can lead to bronchiectasis. Blood tests also can show whether you have an infection or low levels of certain infection-fighting blood cells.
- A sputum culture shows whether a sample of your sputum has bacteria (such as the bacteria that cause tuberculosis) or fungi.
- Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. Lung function tests help show how much lung damage you have.
- A sweat test or other tests can help determine if you have cystic fibrosis.
Bronchoscopy: If your bronchiectasis doesn’t respond to treatment, your doctor may recommend bronchoscopy. Doctors use this procedure to look inside the airways.
During bronchoscopy, a flexible tube with a light on the end is inserted through your nose or mouth into your airways. The tube is called a bronchoscope. It provides a video image of your airways. You’ll be given medicine to numb your upper airway and help you relax during the procedure.
Bronchoscopy can show whether you have a blockage in your airways. The procedure also can show the source of any bleeding in your airways.
How is bronchiectasis treated?
Bronchiectasis often is treated with medicines, hydration, and chest physical therapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated to a section of lung, or you have a lot of bleeding.
If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen therapy.
The goals of treatment are to:
- Treat any underlying conditions and lung infections
- Remove mucus (a slimy substance) from your lungs
- Prevent complications
Early diagnosis and treatment of the underlying cause of bronchiectasis may help prevent further lung damage.
Antibiotics: Antibiotics are the main treatment for the repeated lung infections that bronchiectasis causes. Oral antibiotics often are used to treat these infections.
For hard-to-treat infections, your doctor may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line inserted into your arm. Your doctor may help you arrange for a home care provider to give you IV antibiotics at home.
Expectorants and mucus-thinning medicines: Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus.
Expectorants help loosen the mucus in your lungs. They often are combined with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.
Other medicines: Your doctor may prescribe other medicines, depending on your symptoms or other conditions you may have.
- Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are inhaled medicines. You will use an inhaler or a nebulizer to breathe in a fine mist of medicine. Inhaled bronchodilators work quickly because the medicine goes straight to your lungs. Your doctor may recommend that you use a bronchodilator right before you do CPT.
- Inhaled corticosteroids treat inflammation in the airways. Your doctor may prescribe these if you also have wheezing or asthma with your bronchiectasis.
Hydration: Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery and easier to cough up.
Chest physical therapy: CPT is also known as physiotherapy, chest clapping, and percussion. This technique is generally performed by a respiratory therapist but can be done by a trained member of the family. It involves the therapist patting or gently pounding your chest and back repeatedly with their hands or a device. Doing this helps loosen the mucus from your lungs so you can cough it up.
You can sit with your head tilted down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.
Some people who perform CPT find it hard or uncomfortable to do. Several devices can help with CPT, such as:
- An electric chest clapper, known as a mechanical percussor
- An inflatable therapy vest that uses high-frequency air waves to force mucus toward your upper airways so you can cough it up
- A small handheld device that you breathe out through, which causes vibrations that dislodge the mucus
- A mask that creates vibrations to help break loose mucus from your airway walls
Several breathing techniques are also used to help move mucus to the upper airway so it can be coughed up. These techniques include forced expiration technique (FET) and active cycle breathing (ACB).
FET involves forcing out a couple of breaths and then doing relaxed breathing. ACB is FET that involves deep breathing exercises.
Oxygen therapy: Oxygen therapy is a treatment that delivers oxygen for you to breathe. You can receive oxygen therapy from tubes resting in your nose, a face mask, or a tube placed in your trachea (windpipe). You may need oxygen therapy if you have a condition that causes your blood oxygen levels to be too low.
Oxygen therapy can be given for a short or long period of time in the hospital, in another medical setting, or at home. Oxygen poses a fire risk, so you should never smoke or use flammable materials when using oxygen. You may experience side effects from this treatment, such as a dry or bloody nose, tiredness, and morning headaches. Oxygen therapy is generally safe.
Surgery: Your doctor may recommend surgery if no other treatments have helped and only one part of your airway is affected. If you have major bleeding in your airway, your doctor may recommend surgery to remove part of your airway or a procedure to control the bleeding.
In very rare instances of severe bronchiectasis, your doctor may recommend that you receive a lung transplant replacing your diseased lungs with a healthy set of lungs.