Bronchiectasis is a lung disease that usually results from an infection
or other condition that injures the walls of the airways in your lungs.
The airways are the tubes that carry air in and out of your lungs.
This injury is the beginning of a cycle in which your airways slowly lose
their ability to clear out mucus. The mucus
builds up and creates an environment in which bacteria can grow. This leads
to repeated serious lung infections. Each infection causes more damage to
Over time, your airways become stretched out, flabby, and scarred. They
can no longer move air in and out. This can affect how much oxygen reaches your
body organs. If your lungs cannot move enough oxygen into your body, bronchiectasis
can lead to serious illness, including heart
Bronchiectasis can affect just one section of one of your lungs or many
sections of both lungs.
Bronchiectasis usually begins in childhood, but symptoms may not appear
until months or even years after you have started having repeated lung infections.
There are two types of bronchiectasis:
Congenital bronchiectasis usually affects infants and children.
It results from a problem in the development of the lungs in the fetus.
Acquired bronchiectasis occurs in adults and older children.
It is more common.
Bronchiectasis cannot be cured, but with proper care, most people who have
it can enjoy a good quality of life.
What causes bronchiectasis?
Bronchiectasis is caused by injury to the lower airways. This injury may
be caused by another disease, including:
Cystic fibrosis, which leads
to almost half of the cases of bronchiectasis in the United States.
Whooping cough (uncommon because
most people are now vaccinated against it).
Tuberculosis (TB) and other similar
Immunodeficiency disorders, such as HIV infection and AIDS.
Allergic bronchopulmonary aspergillosis, an allergic reaction to a
fungus called aspergillus that causes swelling in the airways.
Kartagener's Syndrome, a rare inherited disease that involves the
cilia. These are small hair-like structures that line your airways and
normally clear out mucus.
Other disorders that affect the function of the cilia.
Other conditions that can injure the lower airways and lead to bronchiectasis
Blockage of your airways by a growth or a noncancerous tumor
Blockage of your airways by something you inhaled – for example,
a piece of a toy or a peanut that you inhaled when you were a child
Signs and symptoms of bronchiectasis?
The most common signs and symptoms are:
Daily cough, over months or years
Daily production of large amounts of mucus, or phlegm
Repeated lung infections
Shortness of breath
Chest pain (pleurisy)
Over time, you may have more serious symptoms, including:
Coughing up blood or bloody mucus
Bronchiectasis can also lead to other serious health conditions, including:
Heart failure, if the disease advances to affect all parts of your
How is bronchiectasis diagnosed?
There is no one specific test for bronchiectasis. Even in its later stages,
the signs of the disease are similar to those of other conditions, so those
conditions must be ruled out before a diagnosis can be made.
Your doctor may suspect bronchiectasis if you have a daily cough that produces
large amounts of mucus.
Your doctor will determine if you have bronchiectasis by conducting a series
of tests to:
Identify any underlying causes that need to be treated
Rule out other causes of your symptoms
Determine the amount of damage to your lungs
The most commonly used tests to diagnose bronchiectasis are:
Chest X-ray. A chest X-ray
takes a picture of your heart and lungs. It can show infection and scarring
of your airway walls.
Computer tomography (CT) scan. This test provides a computer generated image of your airways
and other tissue in your lungs. It has more detail than a regular chest
X-ray. A CT scan is the defining test for bronchiectasis. It can show
how much damage has been done to the airways and where the damage is.
Other tests your doctor may conduct include:
Blood tests. These tests
can show if you have a disease or condition that can lead to bronchiectasis.
They can also show if you have an infection or low levels of certain
infection-fighting blood cells.
Sputum culture. Sputum contains mucus and often pus, blood,
or bacteria. Laboratory tests of a sample of your sputum can show if
you have bacteria, fungi, or tuberculosis.
Lung function tests.
These tests measure how well your lungs move air in and out. These tests
show how much lung damage you have.
Sweat test or other tests for cystic fibrosis. This is a patch
test on your arm that measures the amount of salt (sodium
chloride) in your sweat.
If your condition does not respond to treatment, your doctor may request
a fiber-optic bronchoscopy. In this
procedure, your doctor inserts a long narrow, flexible tube with a light
on the end through your nose or mouth into your airways. This tube is called
a bronchoscope. It provides a video image of the airways and allows your
doctor to collect samples of mucus. This test can show if something is blocking
your lungs. You most likely would have this procedure as an outpatient in
a hospital, under local anesthesia.
How is bronchiectasis treated?
The goals of treatment are to:
Treat any underlying conditions and respiratory infections
Help remove mucus from your lungs
Early diagnosis and treatment of bronchiectasis are important. The sooner
your doctor can start treating any underlying conditions that may be causing
the bronchiectasis, the better the chances of preventing further damage
to your lungs.
The mainstays of treatment for bronchiectasis are:
Medications, especially antibiotics
Chest physical therapy (CPT)
The main medicines used to treat bronchiectasis are:
Antibiotics are the main
treatment for the repeated respiratory infections that bronchiectasis
causes. Doctors usually prescribe oral antibiotics to treat these infections.
For hard-to-treat infections, you may be given antibiotics through a
tube into a vein in your arm. Your doctor may be able to help you arrange
for a home care provider to give you intravenous antibiotics at home.
Bronchodilators open your airways by relaxing the muscles around
them. Inhaled bronchodilators can be breathed in as a fine mist from
a metered-dose inhaler (puffer) or a nebulizer. These medicines work
quickly because the drug goes directly into your lungs. Doctors usually
recommend that you use a bronchodilator right before you do your chest
reduce inflammation in your lungs.
They work best when you take them with an inhaler.
Mucus thinners, such as acetylcysteine,
loosen the mucus.
Expectorants help loosen the mucus in your lungs. They often
come in combination with decongestants,
which may provide additional relief. You do not need a prescription
Saline nasal washes help control sinusitis.
Chest physical therapy
CPT is also called chest clapping or percussion. It involves pounding your
chest and back over and over with your hands or a device to loosen the mucus
from your lungs so that you can cough it up. You should do CPT for bronchiectasis
three or four times each day.
CPT is often called postural drainage. This means that you sit or lie on
your stomach with your head down while you do CPT. This lets gravity and
force help drain the mucus from your lungs.
Some people find CPT difficult or uncomfortable to do. Several devices have
been developed that may help with CPT. The devices include:
An electric chest clapper, known as a mechanical percussor.
A removable inflatable therapy vest that uses high-frequency air waves
to force the mucus that is deep in your lungs toward the upper airways
so you can cough it up.
A "flutter" device, a small handheld device that you breathe out through.
It causes vibrations that dislodge the mucus.
A positive expiratory pressure mask that creates vibrations that help
break the mucus loose from the airway walls.
Several breathing techniques may also help loosen some of the mucus so you
can cough it up. These techniques include:
Forced expiration technique (FET) – forcing out a couple of
breaths or huffs and then doing relaxed breathing
Active cycle breathing (ACB) – FET with deep breathing exercises
that can loosen the mucus in your lungs
Depending on how serious your condition is, your doctor may also recommend:
Surgery to remove a section of your lung. Doctors usually do this only
if other treatments have not helped and only one part of your lung is
affected. If you have major bleeding, your doctor may recommend either
surgery to remove the bleeding part of your lung or a procedure to control
Living with bronchiectasis
If you have bronchiectasis, you should work closely with your doctor to
develop self-management skills that can improve your quality of life. This
means that you need to learn as much as you can about bronchiectasis and
any underlying conditions that you have.
Avoiding respiratory infections should be a top priority. To do this:
Have annual flu vaccinations
Have pneumonia vaccinations as directed by your doctor
Get regular aerobic exercise (walking and swimming, for example) to
help loosen the mucus so it can be coughed up
Eat a healthy diet
Drink lots of fluids
Wash your hands often
Maintain a healthy weight.
Other things you can do to improve your condition include:
Do not smoke
Avoid exposure to tobacco smoke
Avoid fumes and dust that can irritate your lungs