Bronchiectasis is among a group of lung diseases classified as chronic obstructive pulmonary disease or COPD. It is characterized by an abnormal stretching and enlargement of the bronchi and bronchioles, the larger airways of the lungs.
Often caused by recurrent inflammation and infection of the airways, bronchiectasis may be congenital, meaning present at birth, or a person may be predisposed to it as a result of early childhood diseases, such as pneumonia, measles, influenza or tuberculosis.
Bronchiectasis can occur as part of a genetic defect, such as in primary ciliary dyskinesia or cystic fibrosis. Other pre-disposing factors include abnormal lung defenses and obstruction of the airway by a foreign object or tumor. Bronchiectasis can also be caused by breathing in food particles when you eat or after surgery because of a weakened cough reflex and the inability of the patient to clear their airways effectively.
Bronchiectasis causes an abnormal widening of the airways due to recurrent inflammation and infection. When the airways become dilated, extra mucus begins to pool in the enlarged areas. The pooling of mucus becomes a breeding ground for bacteria which leads to lung infections. This is further complicated by damage to the cilia, the tiny protective hairs that line the airways. When the cilia are unable to clear the airways of debris and extra mucus, airway obstruction occurs. The accumulation of mucus and subsequent bacteria lead to repeated cycles of inflammation, infection and obstruction of the airways and lungs.
Often developing gradually, symptoms of bronchiectasis may not appear for months or even years after the pre-disposing event that caused bronchiectasis to occur in the first place. Symptoms of bronciectasis include:
- Chronic cough that gets worse when lying down
- Thick, foul-smelling mucus
- Dyspnea, worsened by exercise
- Weight loss
- Clubbing of the fingers
- Repeated lung infections
- Chest pain
Doctors can evaluate bronchiectasis by doing the following tests:
Testing for other associated conditions such as cystic fibrosis or tuberculosis may also be helpful in making a diagnosis of bronchiectasis.
The goals of treatment for bronchiectasis are to control infection, promote drainage of excessive secretions from the lungs and prevent further complications. Although the disease can't be cured, with treatment, most people live a normal life.
Treatment options may include any of the following:
- Antibiotics (oral and/or intraveneous)
- Expectorants, decongestants and mucus-thinning medications
- Avoidance of respiratory irritants (smoking, secondhand smoke, air pollution, workplace exposures).
- Yearly flu shot
- Postural drainage
- Chest physiotherapy
- Oxygen therapy
- Surgical lung resection (for those who do not respond to treatment or for massive bleeding)
If your bronchiectasis doesn't respond well to treatment, your doctor may order a bronchoscopy to determine whether a blockage is present in your airways. A bronchoscopy is also a tool used to identify the source of bleeding in your airways.
The chances of bronchiectasis developing decrease with immediate treatment of lung infections. Other preventative measures include:
- Quitting smoking, if you are a smoker. Information on quitting is available at the Smoking Cessation Guide Site.
- Avoiding upper respiratory irritants, such as secondhand smoke or air pollution.
- Vaccinating against measles, influenza and other infections as recommended by your healthcare provider.
When to Contact Your Healthcare Provider
Call your doctor if any of the following occur:
- Your symptoms worsen or fail to improve with proper treatment.
- There is a change in the color or amount of your sputum.
- You develop hemoptysis.
- You develop chest pain or shortness of breath that is unrelieved by rest.
American Lung Association. Understanding Bronchiectasis. 2014.
National Heart, Lung and Blood Institute. How is Bronchiectasis Treated? Updated October 28, 2011
Smeltzer, Suzanne C. & Bare, Brenda, G. (1996). Brunnuer and Suddarth's Testbook of Medical-Surgical Nursing (8th Edition). Pennsylvania, PA: Lipponcott-Raven Publishers.