Bronchiectasis

Bronchiectasis is a long term lung condition where damaged airways cause mucus build-up and repeated, serious lung infections.The main symptom of bronchiectasis is a wet, chesty cough.

Treatment is likely to include antibiotics and other medications, while physiotherapy is used to remove mucus from the lungs. It has been estimated that around one in 550 New Zealanders live with severe bronchiectasis.

Causes

Within the lungs, air passages called bronchi form a tree-like structure through which air flows 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 lifelong 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 of the bronchi and the condition can get progressively worse.

About one-third of adult cases of bronchiectasis are due to a severe lung infection that occurred in childhood. Prior to the introduction of the national immunisation programme, bronchiectasis often occurred as the result of infection with measles or whooping cough. Today, bronchiectasis more commonly occurs as the result of pneumonia.

Other causes include:

• Cystic fibrosis
• Immune deficiency
• Inhaling stomach contents into the lungs
• Inhaling a foreign object into the lungs (if left untreated)
• Inhaling 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 wet cough, which is a cough that brings up mucus (also known as phlegm or sputum). 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.

See a doctor if you or your child develops a persistent wet, chesty cough that lasts four weeks or more.

Diagnosis

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 (sputum test)
• Checking oxygen levels in the blood
• Lung function tests (spirometry).

Treatment

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 treatment are:

Medications

• Antibiotics are used to treat acute lung infections. Where the infection is severe, treatment with intravenous antibiotics in hospital may be required.
• Bronchodilators (as used in people with asthma) to improve the flow of air to the lungs.
• Medicines that reduce inflammation in the lungs.
• Occasionally, medicine to thin the mucus may be used.
• Vaccination against influenza (flu) and pneumococcal pneumonia.

Physiotherapy and exercise

Chest physiotherapy and postural drainage are used to remove mucus from the lungs. An individual programme is usually developed where exercise and breathing techniques to clear the lungs of mucus are practiced.

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.

Prevention

The Ministry of Health recommends the following measures to help prevent bronchiectasis in children:

• Stop smoking (especially during pregnancy) and have a smoke-free home
• Breastfeed your children
• Eating a healthy balanced diet
• Exercising regularly
• Early detection and treatment of chest infections
• Making sure homes are warm and dry (making chest infections less likely)
• Immunise children for diseases like measles and whooping cough, which can lead to bronchiectasis.
• Get an influenza (flu) vaccine every year.
• Prevent infants and children from inhaling foreign objects such as food particles (e.g. avoid giving a bottle to a baby who is lying down and ensure infants are sitting up while eating)
• Seek medical assistance right away if a foreign object is inhaled into the lungs.

References

Asher I., Edwards, E. (2013). Bronchiectasis (Web Page). Starship Clinical Guidelines. Auckland: Starship Children’s Health. https://www.starship.org.nz/guidelines/bronchiectasis/ [Accessed: 17/02/20]
KidsHealth (2017). Bronchiectasis (Web Page). Paediatric Society of New Zealand (Christchurch) and Starship Foundation (Auckland). https://www.kidshealth.org.nz/bronchiectasis [Accessed: 17/02/20]
Ministry of Health (2018). Bronchiectasis (Web Page). Wellington: New Zealand Ministry of Health. www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/bronchiectasis [Accessed: 17/02/20]
NHS (2018). Bronchiectasis (Web Page). Redditch: National Health Service (NHS)
England. https://www.nhs.uk/conditions/Bronchiectasis/ [Accessed: 17/02/20]
O’Toole, M.T. (Ed.) (2017). Bronchiectasis. Mosby’s Dictionary of Medicine, Nursing & Health Professions (10th ed.). St Louis, MI: Elsevier.
Barnard, L. T., Zhang J. (2018). The impact of respiratory disease in New Zealand: 2018 update (Report PDF). Dunedin: University of Otago. https://s3-ap-southeast-2.amazonaws.com/assets.asthmafoundation.org.nz/images/NZ-Impact-Report-2018_FINAL.pdf

Last Reviewed – February 2020

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