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Bronchiectasis: Causes, symptoms, and treatment

Last updated

Last updated Wed 26 Apr 2017

Table of contents

  1. Symptoms
  2. Complications
  3. Causes
  4. Diagnosis
  5. Treatment
  6. Outlook and prevention
Bronchiectasis is a lung condition that causes a persistent cough and excess phlegm, or sputum. It is a permanent condition that gets worse over time. It can be fatal.

The bronchi dilate, usually irreversibly, and phlegm builds up. This leads to recurrent lung infections and lung damage.

It can affect people with tuberculosis and cystic fibrosis , but these are not the only causes. Various processes and mechanisms can trigger this disorder.

There is no cure, but treatment can reduce infections and mucus build up. Symptoms vary in severity.

Older age increases the risk of, but bronchiectasis can affect all ages. In the United States (U.S.), it affects about 25 people in every 100,000. Over the age of 74 years, this increases to about 272 cases per 100,000 people.

The prevalence appears to be increasing.

Symptoms

[cough can be a sign of bronchiectasis]
A persistent cough can be a sign of bronchiectasis.

Symptoms are thought to start when sputum builds up in the respiratory system, leading to a cycle of problems.

More sputum means more bacteria in the airways, and this leads to inflammation and airway destruction. Then the cycle begins again with more mucus.

There are three main types of bronchiectasis, classified according to the resulting shape of the bronchi, visible on a CT scan of the lungs.

They are:

  • Cylindrical: The most common form, with even, cylinder-shaped bronchi
  • Varicose: The least common form. Bronchi are irregular, and the airways may be wide or constricted, leading to a higher production of sputum.
  • Cystic: Almost as common as cylindrical, but the bronchi form clusters of cysts . This is the most severe form.

The different types have similar symptoms are similar across the different types, but they differ in terms of severity.

They all feature enlargement of the breathing tubes of the lungs, or bronchi.

Other symptoms include :

  • a daily cough that continues for months or years
  • daily production of sputum in large amounts
  • shortness of breath and wheezing when breathing
  • chest pain
  • coughing up blood

A person with bronchiectasis who then gets an infection can experience a flare-up, and this can worsen the lung function.

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Complications

In time, flares and infections can lead to complications.

Respiratory failure

When too little oxygen transfers from the lungs into the blood, or too little carbon dioxide, a waste gas, is removed from the blood, respiratory failure can occur.

Symptoms include:

  • shortness of breath
  • rapid breathing
  • air hunger, or the constant need for more air
  • sleepiness
  • bluish skin, fingernails, and lips

Atelectasis

Atelectasis happens when at least one area of the lung fails to inflate properly, leading to shortness of breath, rapid breathing and heart rate, and bluish lips and skin.

Heart failure

At the most advanced stages of bronchiectasis, lung function worsens, putting a strain on the heart. The heart can no longer pump enough blood to meet the body’s needs.

The person may experience:

  • trouble breathing
  • tiredness
  • swelling of the abdomen, neck veins, feet, ankles, and legs

Untreated, it can be fatal.

Causes

Bronchiectasis occurs when a part of the bronchial tree widens irreversibly or dilates.

[in bronchiectasis excess mucus leads to a cycle of damage]
Excess mucus encourages bacteria to thrive, leading to damage in the airways.

A wide range of factors can lead to it, including some congenital and autoinflammatory conditions and infections.

Infections that have been linked to bronchiectasis include :

  • tuberculosis (TB)
  • non-tuberculous mycobacteria
  • pneumonia
  • childhood infections, such as measles and whooping cough

Immunodeficiency conditions include:

  • hypogammaglobulinemia
  • leukemia
  • HIV and AIDS
  • chemotherapy
  • other treatments that suppress the immune system

It has also been linked to :

  • allergic bronchopulmonary aspergillosis
  • obstruction by a tumor or a foreign body
  • gastro-esophageal reflux
  • inhaling toxic fumes
  • auto-inflammatory conditions, such as rheumatoid arthritis , lupus , and ulcerative colitis, or Crohn’s disease
  • cystic fibrosis and some other congenital conditions

Between one third and one half of patients appear to have no identifiable cause.

Cystic fibrosis (CF) is a common cause of bronchiectasis in children. This is called CF bronchiectasis. Non-CF bronchiectasis is when the person has bronchiectasis but not CF.

Between 7 and 25 percent of patients with asthma or chronic obstructive pulmonary disease (COPD) also have bronchiectasis, but how these related to bronchiectasis remains unclear.

How does bronchiectasis affect the lungs?

Air passages in the respiratory system make it possible for oxygen to enter the lungs and for carbon dioxide to leave the body.

In healthy lungs, the bronchial tubes narrow smoothly towards the edges of each lung, but in bronchiectasis, they widen and become collapsible and scarred.

The cilia, the hair-like structures that sweep mucus out of the lungs, no longer function ineffective, so the mucus builds up.

This increased mucus provides a place for bacteria to grow. Ongoing infections increase inflammation, and this leads to worsening lung damage.

Is bronchiectasis the same as COPD?

Bronchiectasis, chronic obstructive pulmonary disease (COPD), and cystic fibrosis are classified as obstructive lung diseases.

COPD refers to a collection of lung conditions that make it difficult to breathe, because the airways become inflamed and narrowed . Two conditions that are classified as COPD are persistent bronchitis and emphysema .

Bronchiectasis and COPD are not the same disorder, but studies suggest that between 25 percent and 50 percent of people with COPD also have bronchiectasis.

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Diagnosis

A person with an ongoing cough, recurrent lung infections, and sputum in the blood may have bronchiectasis.

Tests may include :

  • a chest x-ray
  • a CT scan of the lungs
  • a lung, or pulmonary, function test (PFT)
  • A bronchoscopy, where the doctor uses a lighted tube to look into the lungs, and possibly take a tissue sample

However, laboratory tests do not generally find any specific microorganism in patients that could cause bronchiectasis.

Scientists note that “the bacterial flora appear to change with progression of disease.”

Treatment

Early diagnosis and treatment can help stop the disease from progressing and causing severe complications. Treatment for symptoms can improve the patient’s quality of life.

[if cystic fibrosis leads to bronchiectasis oxygen may be necessary]
Oxygen therapy may be needed in severe cases.

Many of the treatment options developed have been learned from treating patients with cystic fibrosis.

Treatment aims to:

  • deal with underlying conditions or new infections
  • remove mucus from the lungs
  • prevent complications from developing

There are different forms of treatment.

Chest physical therapy (CPT)

Also known as “chest-clapping” or “percussion,” this is normally carried out by a respiratory therapist.

The patient will either sit down with their head downturned or lie face-down. Gravity helps the mucus to shift.

The therapist repeatedly pounds on the chest and back to loosen mucus and enable coughing. This can be done manually, with the hands, or using a device.

Examples of devices include:

  • an electric chest clapper, also known as a mechanical percussor
  • an inflatable therapy vest that uses high-frequency airwaves to shift mucus to the upper airway
  • a mask that causes vibrations to remove mucus from the walls of the airway

Studies indicate that such techniques may slightly improve the lungs’ ability to get rid of sputum, improve lung function, and enhance quality of life, compared with not using these techniques.

Adding in pulmonary rehabilitation may further improve the ability to exercise and quality of life.

Hydration

Consuming plenty of fluids can help keep mucus thinned out, less sticky and easier to cough up.

Medications

Antibiotics are used to treat infections. They may be given intravenously or by mouth, normally for 14 days . Another possibility is inhaled antibiotics, but these may have adverse effects, and more research is needed into their use.

Expectorants and mucus-thinners can help loosen mucus and support coughing.

Inhaled corticosteroids can treat inflammation of the airways that leads to wheezing or asthma.

A bronchodilator relaxes the muscles around the airways. The medicine is breathed in through an inhaler and nebulizer. Used before CPT, these may increase the benefit of the therapy.

Delivering the bronchodilator directly to the airways enables it to work quickly.

Oxygen therapy

Oxygen therapy, delivered through a mask or nasal prongs, can raise oxygen levels. This can be done at home or in a hospital. It is used in severe cases.

Surgery

Surgery may be suitable if:

  • only one part of the airway is affected, so it can be removed
  • there is bleeding in the airway that needs to be stopped

Severe cases may require a lung transplant to replace the diseased lungs with a healthy set of lungs.

This is more common if bronchiectasis results from cystic fibrosis.

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Outlook and prevention

[foreign object in the airway can cause bronchiectasis]
If an adult or a child gets a foreign object in the airway, they should seek medical help to avoid long-term complications.

It is important to seek early treatment for any respiratory condition that could lead to bronchiectasis.

Both adults and children should seek medical help at once if they accidentally inhale a foreign object.

Vaccinations can help prevent measles and whooping cough, childhood diseases that can progress to bronchiectasis.

Avoiding toxic fumes, gasses, and cigarette or other smoke can help preserve respiratory health.

Anyone with a chronic medical condition that increases the risk for bronchiectasis should monitor their lung function and be aware of the early symptoms.

Related coverage

What causes blood in sputum?
Seeing blood in sputum or mucus can be worrying, but it is usually not a cause for concern. If a person is young or generally healthy, these traces of blood are often caused by a mild infection or bronchitis. In serious cases, they can indicate a severe infection or lung cancer. Learn about causes and treatments here.

Read now

What is sputum?
Sputum is a type of thick mucus that is produced by the lungs when they are diseased or damaged. It is a substance known as phlegm, and it can be an indicator of many respiratory infections. This MNT Knowledge Center article explains the types of sputum, what causes these variations, and when to see a doctor.

Read now

COPD and cough: What is the link?
Chronic obstructive pulmonary disease (COPD) refers to a group of conditions, including bronchiectasis, that affect the airways. Symptoms include difficulty breathing and a cough, especially in the morning, as the person tries to move the excess mucus. If coughing becomes severe, this can be a sign of a flareup.

Read now

Restrictive lung disease: Types, causes, and treatment
Restrictive lung disease is a class of lung disease that prevents the lungs from expanding fully, including conditions such as pneumonia, lung cancer, and systemic lupus. Many restrictive lung diseases are irreversible. Learn about different types, symptoms, how it is diagnosed, and treatment options.

Read now

What is the pathophysiology of COPD?
Chronic obstructive pulmonary disease (COPD) is a serious and chronic lung condition that affects breathing. It can be life-threatening. The process known as gas exchange is compromised as lung tissue becomes damaged and loses its elasticity. Find out what happens in the lungs when COPD develops.

Read now

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Additional information

    Article last updated by Adam Felman on Wed 26 April 2017.

    Visit our Respiratory category page for the latest news on this subject, or sign up to our newsletter to receive the latest updates on Respiratory.

    All references are available in the References tab.

References

Citations

    Please use one of the following formats to cite this article in your essay, paper or report:

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    Nordqvist, Christian. “Bronchiectasis: Causes, symptoms, and treatment.” Medical News Today. MediLexicon, Intl., 26 Apr. 2017. Web.
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    APA
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