An Overview of Bronchiectasis

A Chronic Condition Caused by the Permanent Widening of Airways

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Bronchiectasis is the permanent widening of the airways of the lungs, including the bronchi and bronchioles. It can be caused by diseases like tuberculosis or congenital disorders like cystic fibrosis, leading to coughing, wheezing, and frequent lung infection. Bronchiectasis is classified as an obstructive lung disease along with asthma and chronic obstructive pulmonary disease (COPD).

There are several risk factors that can predispose you to bronchiectasis, including smoking and recurrent lung infections. You may need several tests to diagnose bronchiectasis, including imaging studies and pulmonary function tests. If you have bronchiectasis, you can benefit from a variety of medical treatments, including antibiotics, bronchodilators, and chest physiotherapy.

Bronchiectasis affects between 1 in 1,000 and 1 in 250,000 adults, depending on which part of the world you live in. The disease is more common in women, with the risk increasing with advancing age.

Symptoms

Symptoms of bronchiectasis may not be apparent until months or even years after the changes in your lungs have begun. You may initially experience intermittent effects of the condition. The symptoms tend to occur when the lungs are under more strain than usual, such as when you have a lung infection or during physical exertion.

Eventually, as bronchiectasis worsens, you may feel the effects more frequently—often on a daily basis—without any obvious triggers.

Common symptoms of bronchiectasis can include:

If you experience these symptoms, you should seek medical attention. Lung infections might not improve without treatment, such as an antibiotic.

Over time, the effects of bronchiectasis can impact your quality of life and limit your overall ability to walk or get around without becoming severely short of breath. Weight loss, fatigue, weakness, and pain when breathing can occur.

Causes

Inflammation and infection can cause the dilation (widening) of the airways that characterizes bronchiectasis. When this occurs, excessive mucus begins to pool in the enlarged areas.

Damage to the cilia, the finger-like lining of the airways used to clear mucus and debris, can lead to obstruction. Since mucus cannot be easily cleared because of this, it sits in the lungs, becoming a breeding ground for bacteria and leading to further lung infections.

There are a number of causes and risk factors associated with bronchiectasis. The lung damage that leads to bronchiectasis can occur as a result of a congenital lung condition or a respiratory illness.

Although cystic fibrosis remains the leading cause of bronchiectasis, the cause in up to 50% of people without cystic fibrosis is unknown, according to a 2013 study in the American Journal of Respiratory and Critical Care Medicine.

Cystic Fibrosis

Cystic fibrosis, a genetic disorder characterized by the progressive stiffening of the lungs and other organs, remains the leading cause of bronchiectasis in the developed world. It is characterized by abnormal mucus production in the lungs and digestive tract. The mucus build-up in the lungs damages the airways, leading to bronchiectasis.

Recurrent Respiratory Infections

Most respiratory infections improve without producing any long term consequences. But severe or repeated episodes of pneumonia or influenza, especially during childhood, can permanently harm the lungs. Having an immune deficiency can predispose you or your child to aggressive infections.

Measles or tuberculosis, which are typically more severe than usual respiratory infections, can also cause lasting lung damage, predisposing to bronchiectasis.

Inflammatory Conditions

Allergies and asthma may cause thickening of your airways during flare-ups—and this thickening may not resolve after the flare-up resolves. Autoimmune conditions, such as rheumatoid arthritis or lupus, may cause inflammation anywhere in the body, including the lungs.

Ciliary Disease

The cilia are tiny hairs lining your airways that help clear out mucus and infectious organisms. They can be damaged by airborne toxins, including cigarette smoke and environmental pollutants.

A genetic defect, primary ciliary dyskinesia, can make it difficult for you to adequately clear your airways, resulting in a build-up of mucus and inflammation, eventually causing bronchiectasis.

Airway Obstruction

Your airways can become blocked by an object or tumor. Obstruction can occur when you breathe in food particles while eating. You may be more prone to airway obstruction after surgery because a post-operative weakened cough reflex can make it hard for you to clear your airways effectively.

​Diagnosis

The process involved in the diagnosis of bronchiectasis involves a medical history, physical examination, and diagnostic testing. There are a number of causes of chronic coughing and wheezing, such as chronic bronchitis and asthma, so getting an official diagnosis is necessary.

If you have these symptoms, your doctor will assess factors such as whether your condition has been gradually worsening and whether you have episodic flare-ups.

Your physical examination will include an assessment of your breath sounds, as well as your breathing rate, heart rate (pulse), blood pressure. Your doctor will also observe your breathing to determine whether you are struggling to breathe.

An investigation of bronchiectasis is appropriate in otherwise healthy individuals who have cough for more than eight weeks, especially if there is an excess production of mucus and/or the cough worsens with exposure to dust, smoke, or other triggers.

Diagnostic tests in the evaluation of bronchiectasis include:

  • Chest imaging, such as a chest x-ray or chest computerized tomography (CT) scan, provide a visual picture of the structure of your lungs
  • Arterial blood gas, a blood test that measures your blood oxygen, carbon dioxide, and bicarbonate levels
  • Sputum culture is used to grow and identify microbial organisms that could be causing a respiratory tract infection
  • Pulmonary function tests measure how much air volume you can inspire (breath in) and expire (breath out)
  • Lung diffusion test measures the ability of your lungs to absorb gases (such as oxygen and carbon dioxide) as you breathe into a mouthpiece
  • Lung plethysmography involves breathing while sitting in a special booth so that the air inside the booth can be measured to assess your lung volume

Treatments

Although the disease can't be cured, most people who have bronchiectasis are able to live a normal and active life. There are several goals when it comes to the treatment of your bronchiectasis.

Treatment and prevention of infections is an important part of managing bronchiectasis. Maintaining comfort and drainage of excessive secretions from your lungs is another therapeutic target. The prevention of further complications is a key feature of bronchiectasis treatment as well.

The course of treatment can vary from person to person, with some people responding better than others. A 2015 review published in the Cochrane Database of Systemic Reviews could find no clear evidence that any single treatment was universally beneficial.

As such, expert insights from a qualified pulmonologist may be needed to tailor the treatment options best suited for you as an individual.

Lifestyle Approaches

Avoidance of respiratory irritants includes the avoidance of smoking and secondhand smoke. Additionally, air pollution and workplace exposure to toxins can exacerbate symptoms of bronchiectasis. Protecting your lungs from these airborne irritants, whenever possible, can help prevent the worsening of your condition.

Respiratory Medications

A number of medications can help improve your breathing and decrease mucus build-up in your lungs. Bronchodilators, expectorants, decongestants, and mucus-thinning medications can make you more comfortable and can help prevent infections and other complications of bronchiectasis.

Management of Infections

You may need oral (by mouth) or intravenous (IV, through a vein) antibiotics if you have an infection. Having a yearly flu shot is important because bronchiectasis makes you more prone to infections, such as the flu.

Interventional Therapies

There are a number of procedures that can be used on a regularly scheduled basis to relieve mucus build up in bronchiectasis, including postural drainage and chest physiotherapy. Additionally, your doctor may prescribe oxygen therapy for you if you tend to have low blood oxygen levels.

Surgical lung resection is not a common treatment approach in bronchiectasis, but it may be necessary if you have severe lung disease.

A Word From Verywell

If you or your child has risk factors for bronchiectasis, it is important to get medical attention and treatment for respiratory infections because they can worsen the condition. With consistent medical attention and lifestyle strategies, you can minimize the effects and progression of bronchiectasis.

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Article Sources

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  1. Cottin V, Cordier JF, Richeldi L. Orphan Lung Diseases: A Clinical Guide to Rare Lung Disease. New York, NY: Springer; 2015.

  2. Mcshane PJ, Naureckas ET, Tino G, Strek ME. Non-cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2013;188(6):647-56. doi:10.1164/rccm.201303-0411CI

  3. Redondo M, Keyt H, Dhar R, Chalmers JD. Global impact of bronchiectasis and cystic fibrosis. Breathe (Sheff). 2016;12(3):222-35. doi:10.1183/20734735.007516

  4. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1):1-69. doi:10.1136/thoraxjnl-2018-212463

  5. Welsh EJ, Evans DJ, Fowler SJ, Spencer S. Interventions for bronchiectasis: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2015;(7):CD010337. doi:10.1002/14651858.CD010337.pub2