Bronchiectasis is a long term condition, caused by damage to the lungs' airways, that affects their ability to clear out mucus. A result is that mucus builds up, and bacteria begin to grow leading to repeated, serious lung infections. The main symptom of bronchiectasis is a mucus-producing cough. Treatment is likely to include antibiotics and other medications, while physiotherapy is used to remove mucus from the lungs.
Bronchiectasis can develop at any age but it is more likely to occur in childhood. In New Zealand, Pacific Island and Maori children are significantly more at risk of developing the condition than children of other ethnicities, with at least 80% of all cases occurring in these ethnic groups. It is estimated that approximately one new case of bronchiectasis is diagnosed in New Zealand every ten days.
Within the lungs, air passages called bronchi form a tree-like structure through which air travels in and out. The bronchi are lined with tiny hair-like projections called cilia, which work to sweep mucus upwards within the lungs, allowing it to be easily coughed out.
Bronchiectasis is a condition in which some of the bronchi have become scarred and permanently enlarged. During the disease process the cilia are damaged so that they are unable to effectively sweep away the mucus. As a result, mucus accumulates in parts of the lung that are affected and the risk of developing lung infections is increased. Recurrent infections can then cause further scarring and bronchial enlargement thereby perpetuating the condition.
Prior to the introduction of widespread immunisations programs, bronchiectasis often occurred as the result of infection with measles
or whooping cough
Currently bronchiectasis usually occurs as the result of an illness such as pneumonia (approximately 25% of all cases). Other causes include:
- Cystic fibrosis
- Immune deficiency
- Recurrent aspiration of fluid into the lungs (as occurs with gastroesophageal reflux)
- Inhalation of a foreign object into the lungs (if left untreated)
- Inhalation of harmful chemicals eg: ammonia
- In rare cases it may be congenital (present at birth).
In many cases the underlying cause of the condition is unable to be identified.
Signs and symptoms
The main symptom of bronchiectasis is a mucus-producing cough. The cough is usually worse in the mornings and is often brought on by changes in posture. The mucus may be yellow-green in colour and foul smelling, indicating the presence of infection. Other symptoms may include:
- Coughing up blood (more common in adults)
- Bad breath
- Wheezing chest - a characteristic crackling sound may be heard when listening with a stethoscope.
- Recurring lung infections
- A decline in general health
- In advanced bronchiectasis, breathlessness can occur.
The onset of symptoms often occurs slowly. As the disease progresses, coughing worsens and increasing amounts of mucus are produced.
An initial diagnosis of bronchiectasis is based on the patient's symptoms, their medical history and a physical examination. Further diagnostic tests may include:
- Chest x-ray
- CT (computerised tomography) scan
- Blood tests
- Testing of the mucus to identify any bacteria present
- Checking oxygen levels in the blood
- Lung function tests (spirometry).
Bronchiectasis is a chronic (long-term) condition that requires lifelong maintenance. Good management of the condition is vital to prevent ongoing damage to the lungs and worsening of the condition. The ultimate goal of treatment is to clear mucus from the chest and prevent further damage to the lungs. The two main types of treatments used are:
Some or all of the following groups of medications may be used:
- Antibiotics are used to treat acute lung infections. Where the infection is severe, hospitalisation and treatment with intravenous antibiotics may be required.
- Bronchodilators (as used in people with asthma) to improve the flow of air to the lungs.
- Corticosteroids to reduce inflammation in the lungs.
- Occasionally, medications to thin the mucus may be used.
- Vaccination against flu and pneumococcous.
Physiotherapy and exercise
Chest physiotherapy and postural drainage are used to remove secretions from the lungs. An individual program is usually developed where exercise and breathing techniques to clear the lungs of mucus are taught.
Other factors important in managing the condition include avoiding dust, smoke and other respiratory irritants, and maintaining a balanced nutritious diet.
It is also important to identify and treat any underlying conditions that lead to the development of bronchiectasis.
In some cases of severe bronchiectasis, surgery may be suggested to remove the affected portion of the lung. However this is only an option if the disease is localised in one or two small areas of the lungs.
The Ministry of Health recommends the following measures to help prevent bronchiectasis in children:
- Not smoking during pregnancy and having a smoke free home
- Breastfeeding your children
- Eating a healthy balanced diet
- Early detection and treatment of chest infections
- Making sure homes are warm and dry (making chest infections less likely)
- Immunisation for diseases like measles and whooping cough which can lead to bronchiectasis.
Protecting infants and children from inhaling foreign objects such as food particles. Seeking medical assistance right away if a foreign object is inhaled into the lungs is also important.
Asthma Foundation (2012) Bronchiectasis. asthmafoundation.org.nz/your-health/other-respiratory-conditions/bronchiectasis/
Carson-DeWitt, Dr R. (2006) Bronchiectasis. In the Gale Encyclopaedia of Medicine. Third Edition. Jacqueline L. Longe, Editor. 5 vols. Farmington Mills, MI: Thompson Gale.
Edwards, Dr E. (2008) Bronchiectasis - Acute respiratory exacerbation. Starship Children’s Health Clinical Guidelines. Starship Children’s Hospital. Auckland.
Ministry of Health (2012) Bronchiectasis. Ministry of Health. Wellington www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/bronchiectasis
Veale, A. Respiratory and Sleep Physician. Personal communication (2009).
Last Reviewed – May 2013