Bronchiectasis

Air goes in to the lungs via the windpipe (trachea) which divides into a series of branching airways called bronchi. Air goes from the airways into millions of tiny air sacs (alveoli). Oxygen from the air is passed into the bloodstream through the thin walls of the alveoli.

Tiny glands in the lining of the airways make a small amount of mucus. The mucus keeps the airways moist, but also traps any dust and dirt in the inhaled air. There are many tiny 'hairs' (cilia) on the surface of the cells lining the airways. The millions of cilia lining the airways 'sweep' the mucus to the back of the throat to form sputum (phlegm) which is swallowed. Coughing also helps to clear the airways.

What is bronchiectasis?

Bronchiectasis is a permanent abnormal widening (dilation) in one or more of the airways (bronchi). Extra mucus tends to form and pool in the parts of the airways that are widened. Widened airways with extra mucus are prone to infection.

The extent of bronchiectasis can vary greatly. There may be only one section of one airway that is widened and abnormal. At the other extreme, many airways may be widened. Many affected people fall somewhere between these extremes.

The widened parts of the airways are damaged and inflamed. This causes extra mucus to form which is less easily cleared. These parts of the airways are also more 'floppy' and liable to collapse inwards which may affect air flow through the affected airways. The severity of symptoms depends on how many of the airways are affected, and how badly.

The cause is often not clear and no cause can be found in over half of cases. An underlying cause is found in about 4 in 10 cases. Some conditions that affect or damage airways can cause bronchiectasis. Examples include the following.

• Some inherited conditions. For example, a condition called primary ciliary dyskinesia affects the cilia so they do not 'beat' correctly to clear the mucus. Cystic fibrosis is another condition that affects the lungs and causes 'bronchiectatic' airways. Some rare immune problems can cause lung infections and damage to airways.
• Inhaled objects, such as peanuts, can become stuck and block an airway. This may lead to local damage to that airway. Acid from the stomach that is regurgitated and inhaled can also damage airways. Inhaling poisonous gases may also cause damage.
• Severe lung infections such as tuberculosis (TB), whooping cough, pneumonia or measles can damage the airways at the time of infection. Ongoing bronchiectasis may then develop.

• Coughing up lots of sputum is the main symptom. The amount of sputum can vary, depending on the severity. It can be very tiring to cough up large amounts of sputum each day.
• Tiredness and poor concentration are common.
• Wheeziness is common.
• You may cough up some blood from an inflamed airway.
• About 1 in 3 people with bronchiectasis also have chronic (persistent) sinusitis. This may cause an increase in mucus from the nose (catarrh).
• Recurring chest infections are common. This is because an inflamed airway with extra mucus that does not clear easily is ideal for bacteria (bugs) to grow and multiply. Sputum turns greeny/yellow when it is infected.

The severity of symptoms varies greatly. Many people have only mild symptoms and become used to an intermittent cough. They may have the occasional chest infection, but a diagnosis of bronchiectasis is never made, or is made years after symptoms begin. At the other extreme, some people have severe symptoms with an almost permanent chest infection.

Tests may be advised if bronchiectasis is suspected. A lung scan and other lung and sputum tests help to confirm the diagnosis. Other tests may be advised if an underlying cause is suspected.

• Physiotherapy is thought to be an important part of treatment. This helps you to cough up and clear the mucus This may prevent a build-up of infected mucus, which may prevent chest infections. A physiotherapist will advise on the correct way to drain the affected areas. This usually means that once or twice a day you should adopt a 'head down' position and do some controlled breathing exercises to clear the build up of mucus. This is often combined with chest clapping by yourself, or by a relative, carer, or friend. It takes time and effort to do this properly and regularly.
• Exercise. If you are able, a daily exercise such as running, walking, swimming, dancing, aerobics, etc, helps to clear the mucus too.
• Antibiotics. If you have mild bronchiectasis, you may need a course of antibiotics every 'now and then' to clear chest infections as and when they occur. A change of the colour of your sputum to green and feeling unwell usually indicates that you have a chest infection. If you have severe bronchiectasis, you may find that chest infections return quickly once you stop taking antibiotics. In this situation you may be advised to take antibiotics every day to keep chest infections away.
• Immunisation against the pneumococcus bacterium and an annual 'flu jab' is advised. This reduces the chance of some types of chest infection developing.
• Smoking makes symptoms worse and smokers are very strongly advised to stop.
• Treatment of underlying conditions. As mentioned above, about 4 in 10 people with bronchiectasis have an underlying cause and additional treatments may be advised.
• Surgery may be an option if you have a small local area of lung damage causing symptoms. Cutting out the damaged airway may cure the problem. Surgery may be considered even if you have widespread bronchiectasis. This may be to cut out a particularly bad area of lung that is acting as a reservoir for mucus and infection. Occasionally, a lung transplant may be considered in severe cases.

Most people with bronchiectasis (with no underlying cause) have a good outlook. Symptoms do not usually become severe. Regular physiotherapy, and antibiotics when an infection occurs, keeps most people reasonably well.

The condition becomes worse in some cases, and breathing problems may develop. In a small number of cases the condition becomes gradually worse over time as more and more of the airways become affected.

The outlook for people where bronchiectasis is part of another condition depends on the underlying cause.

© EMIS and PIP 2004   Updated: November 2002   CHIQ Accredited