Basics of Bronchiectasis
Basic information about bronchiectasis such as symptoms, causes, and treatments.
What is Bronchiectasis?
It is a lung disease with enlargement of small airways. This leads to a slowed movement of mucus out of the lungs. Holding mucus in the airways may lead to repeated lung infections causing more damage. Bronchiectasis is often found with high-resolution computed tomography (HRCT).
Figure A shows a cross-section of the lungs with normal airways and with widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis. Illustration courtesy of NIH/NHLBI.
Normal lungs have built-in systems to stay clean and clear of mucus. Mucus from the lungs is called sputum. In healthy lungs, cilia (tiny hair-like structures) move normal amounts of mucus out of small airways into large airways and throat. With this lung disease cilia don’t move as well and sputum is more likely to pool in the small airways. The sputum becomes a place for bacterial growth, repeated infections, airway damage and more severe disease with worsening airway enlargement.
What are the symptoms?
- Frequent coughing (often with thick, discolored sputum in varying amounts)
- Repeat chest infections
- Increased tiredness
- Coughing up blood
- Unexplained fever, chills, sweats and weight loss
- Chest pain
Is it contagious?
No, the disease is not passed on to others. It’s also unlikely for others to get sick from you but, people with bronchiectasis are more likely to get sick from others. This is why it’s important to get a flu shot every year and a pneumonia shot when suggested. Washing hands regularly and avoiding illness is also important.
What are the causes?
About half of the time, the cause is unknown. This is called “idiopathic”. The causes of bronchiectasis include:
- Idiopathic bronchiectasis where a cause is not found, even after testing.
- Other causes include infectious, inflammatory and allergic diseases like Allergic Bronchopulmonary Aspergillosis (ABPA). ABPA is a type of fungus and sometimes referred to as a mold. Nontuberculous Mycobacteria (NTM), inflammatory bowel disease, and frequent aspiration (breathing food and/or stomach contents into the lungs) are others.
- Frequent lung infections can be caused by a poor immune system that is inherited or gained at some point after birth.
- Cystic Fibrosis (CF) is the most common of all the genetic causes of bronchiectasis. It is often found by newborn screening, but sometimes it’s found in teens and adults. Testing for CF requires a sweat chloride test and/or genetic testing.
- Primary Ciliary Dyskinesia (PCD) is a genetic disorder linked to slowed movement of the cilia in the airways. This causes repeat ear infections, sinus infections and bronchiectasis. PCD is found by testing for nasal oxide levels, looking at cilia under a microscope and/or genetic testing. There is often a history of pneumonia and sinus infections or breathing problems soon after birth.
What are the treatments?
Regardless of the cause, there are two key parts to proper treatment. First, it’s important to remove sputum from the airways and secondly, to treat infections.
Keeping the airways clear
It’s important to keep sputum moving up and out of the lungs to avoid pooling of mucus and infections. This can be done in several ways:
- Breathing treatments
- Using a hand held airway clearance device (Aerobika, Acapella, Flutter, Lung Flute, Quake, etc.)
- Breathing treatments with positive expiratory pressure helps keep the airways open during exhalation (Cornet, EZPap, Pari PEP, etc.)
- Percussion therapy (Afflovest, inCourage, SmartVest, The Vest, etc.)
- Chest physiotherapy by hand (often called CPT)
- Aerobic exercise for 20-30 minutes per day
- Drink plenty of water
- Special inhaled medications
It’s vital for your health care provider to know what infection is present to treat it with the best antibiotics. This process involves collecting a sputum sample to find bacteria, viruses, fungi (mold) or mycobacteria that are present in the airways. Some health care providers test the sputum every three months, even when the person is not sick. A breathing treatment with salt water may help to cough up a sputum sample. This is called a sputum induction.
Sometimes a video scope may be used to look into the airways and collect a sputum sample. Patients may have bacteria during every sputum test, but this doesn’t always mean it should be treated. Others may have “normal organisms” found in their sputum even during an active infection. Treatment (inhalers, nebulized medications, pills or injections) is tailored for each patient, their symptoms and how well they respond to treatment.
What is an exacerbation?
This occurs when bronchiectasis suddenly gets worse and makes a person sick. This is often called a flare-up. Treatment for a flare-up may differ from other lung infections. It may need a longer course of antibiotics or a combination of antibiotics. These may be given by oral, inhaled or intravenous (IV) routes. It’s important to tell a health care provider about early warning signs of a flare-up so treatment can be started right away.
The main goal of treatment is to prevent or slow airway damage caused by flare-ups and a cycle of repeated infections leading to more severe disease. Early warning signs of a flare-up may include:
- Change in color, thickness, odor or amount of mucus
- Increased coughing
- Increased shortness of breath
- Increased tiredness that lasts more than one day
- Low grade fever that doesn’t go away
- Coughing up blood
- Increased use of rescue medications
- New or increased ankle swelling
- Decrease in lung function by at least 10%
- Chest pain
- Blue color in lips or fingers
Is there a cure?
There is often no cure for bronchiectasis, but it can be treated. Watch for early warning signs of a flare-up and work with a health care provider to find the best treatment plan. In a few rare cases, surgery to remove damaged lung tissue, found in only one area of the lung, may be curative. Research and clinical trials are taking place now to find better treatments and cure(s) for bronchiectasis.
To learn more about the current research being conducted, visit the Participate in Research section.
The COPD Foundation is grateful to Bayer Healthcare for their funding to support the creation of the Basics of Bronchiectasis.