Bronchiectasis

What is bronchiectasis?

Bronchiectasis is a condition that affects the airways to the lungs. It’s usually caused by an infection or other inflammatory condition. You can also be born with a condition that makes it more likely to develop. Bronchiectasis injures the walls of the airways. Over time, they become scarred and flabby. They then can’t clear out mucus. This damage can lead to serious lung infections and other major health problems.

The airways consist of a series of branching tubes. These are called the bronchi and the smaller bronchioles. Through these tubes, the lungs bring oxygen into the body. They also remove carbon dioxide from the body.

The airways usually have a coating of mucus. This sticky substance helps to remove dust, bacteria, and debris from the airways. Tiny hair-like structures called cilia help move the mucus along. This process clears away mucus. Over time, you then swallow or cough it up.

Different conditions, such as an infection, can cause mucus to build up in the airways. This buildup creates an ideal place for bacteria to grow. That can lead to more infections. Every infection hurts the airways a little more. They are then prone to further infection.

Over time, these repeated infections can permanently damage the walls of the airways. The airways widen. They become scarred and thickened. Over time, they may not be able to transfer oxygen in the air from the lungs to the body. Anyone can develop bronchiectasis. But it is more common in women. Among children, it appears more often in boys than in girls.

Bronchiectasis is not common in the U.S. It is more widespread in parts of the world that have poor access to healthcare and an increased risk of lung infections.

What causes bronchiectasis?

Anything that causes constant damage to the airways can lead to bronchiectasis. Smoking is one example. Lung infections are also a major cause. So, too, are diseases that either damage the lungs themselves or make lung infections more likely. These include:

• Cystic fibrosis (leads to nearly half of the cases in the U.S.)
• Severe pneumonia infection
• Chronic obstructive pulmonary disease (COPD)
• Whooping cough or measles
• Tuberculosis
• Fungal infections
• Immunodeficiency disorders
• Allergic bronchopulmonary aspergillosis (ABPA)
• Disorders that affect cilia function
• Chronically inhaling food or liquids into the lungs
• Certain autoimmune diseases, like rheumatoid arthritis
• Airway blockage (like from an object inhaled as a child or from a tumor)
• Congenital problems with lung development

In many cases, the exact cause is unknown.

Who is at risk for bronchiectasis?

You are more likely to get bronchiectasis if you have a condition that damages your airways or raises your chance of a lung infection. Treating these health problems can lower your risk of bronchiectasis.

What are the symptoms of bronchiectasis?

Damage to the airways often starts in childhood. You may not have symptoms until months or years after repeated infections. Common signs include:

• Persistent cough (may become bloody)
• Large amounts of sputum production daily (material coughed up)
• Shortness of breath
• Wheezing
• Chest pain
• Thickening of the flesh under your fingernails and toenails (clubbing)
• Fatigue
• Failure of a child to gain weight and grow properly

Some people have few or no symptoms. Others have daily symptoms that get worse over time.

How Is bronchiectasis diagnosed?

Your healthcare provider will first ask you about your medical history. He or she will also give you an exam. You may need tests to help with the diagnosis. These tests may help identify underlying causes that might need treatment. The tests may include:

• Chest CT, to show precise pictures of your airways, typically used to make the diagnosis
• Chest X-ray, to get information about your heart and lungs
• Blood tests, to figure out if you have an underlying condition
• Sputum culture, to see whether your sputum contains certain bacteria or fungi
• A sweat test, or genetic testing, to rule out cystic fibrosis
• Blood tests, to figure out if you have low levels of antibodies (known as immunoglobulins) in your blood
• Lung function tests, to see how much lung damage you have
• Bronchoscopy, to look inside the airways if you don’t respond to treatment

How Is bronchiectasis treated?

Bronchiectasis is often treated with medicine. You may also need physical therapy. You should stay hydrated, too. Drinking enough water can help prevent the mucus from thickening, which can make it hard to cough up.

Some possible medicines you may take are:

• Antibiotics, to treat the repeated infections
• Bronchodilators, to relax your airway muscles and make breathing easier
• Inhaled steroids to decrease the inflammation (often combined in the same inhaler as bronchodilators)
• Expectorants and mucus thinners, to help loosen the mucus in the lungs and make it easier to cough up
• Decongestants, to help relieve congestion

Chest physical therapy is another important part of treatment. It involves pounding your chest and back repeatedly to loosen the mucus from your lungs. You may also learn special breathing techniques. These can move the mucus into the upper part of your airway so that you can cough it up. Your healthcare provider may also give you devices such as flutter valves, or acapella valves. These help move and clear mucus from your lungs. A variety of devices are available. Your healthcare provider will review the options that are best for you.

Some people may need oxygen therapy. Oxygen levels in their blood may be too low. Your healthcare provider may also advise surgery. It may be an option if other treatments haven’t worked and the condition is isolated in one area of the lung. In rare cases, you might need a lung transplant.

Your treatment plan will depend on the severity of your symptoms, your other medical conditions, and other factors. Early diagnosis and treatment can stop the condition from getting worse.

What are the complications of bronchiectasis?

Respiratory failure is one possible complication. It happens when not enough oxygen passes from your lungs into your blood. It can cause severe shortness of breath. Your skin may also turn a bluish color. You might need oxygen therapy or CPAP (continuous positive airway pressure).

As the airways become damaged, it may cause some of the blood vessels in the airways to have thinner walls which are more likely to break open and cause bleeding from the lung. This is called hemoptysis.  

If the mucus becomes thick and blocks the entire airway, a part of your lung may also collapse. That can cause more shortness of breath.

What can I do to prevent bronchiectasis?

The following steps can help prevent bronchiectasis:

• Make sure you and your children have received the vaccines for measles and whooping cough.
• Avoid harmful substances that can damage your lungs, such as smoke, gases, and fumes.
• Seek treatment right away for any lung infections.
• Watch children to make sure they don’t inhale small objects. Get medical care right away if that happens.
• Quickly treat any condition that can cause bronchiectasis.

How to manage bronchiectasis

Your health care provider will tell you how to manage bronchiectasis. These instructions might include:

• Being vaccinated for the flu and pneumonia
• Washing your hands frequently
• Quitting smoking
• Eating a healthy diet
• Staying hydrated
• Staying physically active

When should I call my healthcare provider?

Call your healthcare provider right away if you have the following symptoms:

• Fever
• Difficulty breathing
• Other signs of an infection

If your symptoms are worsening, plan to see your healthcare provider soon.

Key points

• Bronchiectasis is a condition that affects the airways to the lungs. Over time, the airways aren’t able to clear mucus as well as before. Infections are then more likely to occur.
• It’s usually caused by an infection or other inflammatory condition. You can also be born with a condition that makes it more likely to develop.
• Over time, it can cause serious health problems in some people. These include heart or respiratory failure.
• Early treatment of respiratory illnesses can help prevent bronchiectasis. It can also keep it from getting worse.
• Treatment may include medicine and physical therapy. You may also need to make some lifestyle changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.