What is bronchiectasis?
What is the cause?
How does it develop?
How is it diagnosed?
What are the symptoms?
How is it treated?
What can go wrong?
Air is carried into your lungs through a series of branching tubes (called bronchi). The bronchi contain tiny glands that produce a small amount of mucus. This helps to keep your tubes moist and traps the dust and germs that you breathe in. The mucus is then normally moved away by tiny hairs (called cilia) which line the tubes.
When your bronchial tubes get damaged, they cannot clean themselves. Mucus builds up, spilling over into other tubes. These tubes are then more likely to be infected by bacteria. This causes inflammation and leads to damage called 'bronchiectasis'.
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There are several known causes including:
- Underlying genetic disease such as cystic fibrosis - where the mucus in the bronchial tubes is too thick - or 'primary ciliary dyskinesia' - where the hairs lining the bronchial tubes do not work properly
- Blockage caused by scarring. When damaged bronchial tubes heal, they can be scarred. The scarring can lead to blockages. This can happen if you've had infections such as childhood pneumonia, whooping cough or measles
- Blockage of the bronchial tubes by food, like peanuts
- Lack of immunity to infection, for example: a lack of antibodies which occasionally happens if you get a virus infection in adult life
- Heartburn - but this is rare.
However, over half the people with bronchiectasis in the UK have no obvious cause for it.
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Almost all causes of bronchiectasis make your bronchial tubes less able to clear mucus.
If live bacteria survive in the tubes, they become inflamed and white blood cells are sent by the body to kill the bacteria. If, for a variety of reasons, these cells can't stop the inflammation, the chemical they produce can damage surrounding healthy tissue.
This damage leads to further infection which means your tubes get more inflamed and produce more mucus.
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If you have a persistent cough, producing infected sputum, there are three categories of tests your doctor should carry out:
- a test to find out whether the symptoms are due to bronchiectasis and, if so, what it is and how bad it is. This is done by high-resolution CT scan which is painless
- tests to see if it has affected your lung function and to find out what bacteria are present in your sputum
- blood tests and a test to see how much salt is present in your sweat. Your doctor may need to use a very small, flexible telescope (a bronchoscope) to see if you have a blockage.
- Men may need a fertility test.
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The most common symptom is coughing up phlegm, often in large amounts, every day. This is very tiring and many people find it embarrassing. Even taking this into account, people often feel very tired and have a lack of concentration.
80 per cent of people with bronchiectasis also have wheezy shortness of breath. One third have long-term sinusitis.
Less common symptoms are coughing blood (haemoptysis), chest pain and joint pain.
You can also have additional symptoms of connected conditions. For example: bloody diarrhoea from a condition called ulcerative colitis; rheumatoid arthritis; and infertility (mainly in men).
Your doctor may also be able to hear crackles in your chest because of retained mucus in your tubes.
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- Surgery - if there is no underlying cause which may lead to bronchiectasis happening again, and the bronchiectasis is only in one small part of your lung which could be removed without harming your breathing, then an operation to remove it may be possible - but this is rare.
- If the cause can be found, it must be treated (for example, by antibody replacement if you have low antibody levels)
- Exercise - regular exercise such as walking or swimming helps to loosen mucus so that you can cough it up more easily
- Daily physiotherapy - you can do this yourself, using coughing exercises or gravity to drain your infected tubes
- Anti-asthma treatment - this can improve air flow through your bronchial tubes
- Nasal drops and sprays - these can help if you have a nose infection, sinus infection or a runny nose
- Antibiotics - to treat infections, you take these at regular intervals or continuously, into a vein or by inhaling
- Treatment of any associated disease.
Your doctor will monitor how successful your treatment is. This means your treatment can be changed quickly to meet your needs.
A number of treatments to help with clearing mucus and to reduce inflammation are being tested for the future.
To prevent the disease we will need to be able to identify who is likely to get it.
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Complications which can take place are:
• coughing blood (haemoptysis) which rarely requires treatment
• infection being spread by the blood to other areas of the body
• a lung abscess - but these are rare
To make sure your treatment remains effective, keep in regular contact with your doctor.
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Page last medically reviewed: April '07
