What Is Bronchiectasis?

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

Several risk factors 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 may benefit from a variety of medical treatments, including antibiotics, bronchodilators, and chest physiotherapy.

This article will discuss the symptoms and causes of bronchiectasis. It will then go into the diagnosis and treatment of bronchiectasis.

Bronchiectasis 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:

• Chronic cough that gets worse when lying down
• Thick, foul-smelling mucus when you cough
• Dyspnea (shortness of breath)
• Exercise intolerance, dyspnea with physical exertion
• Wheezing
• Recurrent lung infections
• Hemoptysis (coughing up blood)
• Clubbing of the fingers

If you experience these symptoms, make sure to 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.

What Causes Bronchiectasis?

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 that 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.

The lung damage that leads to bronchiectasis can occur as a result of a congenital lung condition or a respiratory illness. A person may be born with bronchiectasis.

Common causes include:

• Cystic fibrosis (CF): This genetic disorder is characterized by the progressive stiffening of the lungs and other organs with abnormal mucus production in the lungs and digestive tract.
• Respiratory infections: Severe or recurrent pneumonia or influenza, especially during childhood, can permanently harm the lungs. Measles or tuberculosis are closely associated with bronchiectasis.
• Inflammatory conditions: Allergies, asthma, and autoimmune conditions may lead to bronchiectasis by causing thickening of your airways.
• Ciliary disease: Cilia can be damaged by airborne toxins, including cigarette smoke and environmental pollutants. Primary ciliary dyskinesia is a genetic condition that results in a build-up of mucus and inflammation, eventually causing bronchiectasis.
• Airway obstruction: Your airways can become blocked by an object (such as a food particle) or a tumor. You may be more prone to airway obstruction after surgery because of a post-operative weakened cough reflex.

​How Bronchiectasis Is Diagnosed

Diagnosis of bronchiectasis involves a medical history, physical examination, and diagnostic testing. If you have symptoms, your healthcare provider 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), and blood pressure. Your practitioner will also observe your breathing to determine if you are struggling to breathe.

In addition to your physical examination, your healthcare provider may order some specific tests, such as:

• Imaging tests: Chest imaging may include a chest X-ray or chest computerized tomography (CT) scan.
• Lab tests: You may need an arterial blood gas 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.
• Specialized tests: Pulmonary function tests measure how much air volume you can inspire (breathe in) and expire (breathe out). A lung diffusion test compares the amount of carbon monoxide in the air you inhale versus the amount in the air you exhale; the ability to process carbon monoxide is a measure of lung strength and health. Lung plethysmography assesses your lung volume.

What Is the Treatment for Bronchiectasis?

Although the condition is incurable, most people who have bronchiectasis live a normal and active life, and the condition does not shorten life expectancy. There are several goals when it comes to the treatment of your bronchiectasis.

Treatment and prevention of infections is an important part of management. 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.

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

Treatment options include a combination of the following:

• Lifestyle approaches: Avoidance of respiratory irritants includes the avoidance of smoking, secondhand smoke, air pollution, and workplace exposure to toxins.
• Respiratory medications: Bronchodilators, expectorants, decongestants, and mucus-thinning medications can help you breathe and decrease mucus in the lungs.
• Management of infections: You may need 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: Procedures that can be used on a regularly scheduled basis to relieve mucus build-up in bronchiectasis include postural drainage and chest physiotherapy. You may need oxygen therapy if you tend to have low blood oxygen levels.
• Surgical lung resection: This is not a common treatment approach in bronchiectasis, but it may be necessary if you have severe lung disease.

Summary

Bronchiectasis is the permanent widening of lung airways that can occur because of other medical conditions, including cystic fibrosis, respiratory infections, and inflammatory conditions. You may not experience any symptoms for months or even years. When symptoms do occur, they may include a chronic cough that gets worse when lying down and comes with thick and foul-smelling mucus, shortness of breath, wheezing, recurrent lung infections, and more.

Bronchiectasis is incurable, but people with the condition can lead an active lifestyle. Treatment options include lifestyle changes like avoiding respiratory irritants, respiratory medications, interventional therapies, infection management such as a yearly flu shot, and, in severe cases, surgery. With consistent medical attention and lifestyle strategies, you can minimize the effects and progression of bronchiectasis.