Bronchiectasis

Bronchiectasis

Bronchiectasis is a condition where the airway (bronchi) in the lungs become widened and damaged.

In healthy lungs a small amount of mucus is secreted into the bronchi. This acts as a protective lining, trapping dust and bacteria that have been breathed in. To prevent a build-up of this mucus, the bronchi are lined with microscopic hairs, called cilia, which clear the mucus from the airways.

In bronchiectatic lungs these cilia do not effectively clear the mucus so it builds up, making the bronchi prone to infections which can spread. If you get repeated infections, the bronchi can become permanently widened and damaged. This damage results in permanent lung inflammation, and overproduction of mucus from the mucus glands.

To find out more about bronchiectasis, have a look on the British Lung Foundation website.

There is often no obvious cause, but it may be because of one or more of the following:

• Mechanical causes, for example, inhalation (breathing in) of a foreign body.
• Damage to the lung from previous (often childhood) illness. TB, measles, whooping cough and pneumonia can all result in scarring of the lungs and a reduced immunity to further lung infections.
• Immunodeficiency syndromes, for example, HIV.
• Poor cilia action, for example, ciliary dyskinesia. There is where the cilia do not move at the same time, so it is more difficult to clear the mucus from the airways.

The symptoms of bronchiectasis can include:

• A cough, producing mucus or phlegm. This is because of an increase in the amount of mucus produced in the lungs and/or poor mucus clearance.
• Wheeze. This is because of a narrowing of the airways caused by muscle spasm.
• Shortness of breath. This happens as a result of inflammation, which reduces the elasticity and muscle tone in the bronchial tubes. These then collapse and become infected.
• Other symptoms can also include: runny nose or chronic sinusitis, coughing up blood (haemoptysis), chest and joint pain

Bronchiectasis is diagnosed by:

• Chest x-ray
• CT scan
• Bronchoscopy
• A bacterial check, called sputum culture
• Lung function tests. These show the volume of air you are capable of breathing out, and how forcefully you can breathe out.
• Blood tests (white blood cell count), to find out whether there is any active infection.

You may have one or more of these symptoms if you have an infection:

• An increased amount of sputum.
• Green, yellow, grey or brown sputum.
• Increased frequency and duration of cough, including night coughing.
• Blood stained sputum. This is caused when small blood vessels in the lungs become damaged, usually because of excessive coughing.
• Increased breathlessness and a reduced exercise tolerance.
• Change in taste or smell of your sputum. If you notice any or all of the above symptoms, you should see your GP as soon as possible.

In the 1950 and 1960s lung surgery for bronchiectasis was quite common. Nowadays, surgery will only be performed if a patient has severe but localised disease.

In the case of a severe exacerbation or a ‘flare-up’, it may be necessary to admit you to hospital where more intensive treatment can be given.

Here are some common medications to treat bronchiectasis. Your doctor will decide which is most appropriate for you:

Steroids These reduce inflammation and the amount of sputum produced.

Antibiotics This is to treat infection.

Bronchodilators This makes breathing easier and reduces breathlessness and wheezing by reducing muscle spasm in the bronchi. For more information about treatment for bronchiectasis, have a look at the British Lung Foundation website.

• Give up smoking and avoid exposure to passive smoke. Ask your healthcare provider for techniques to help you give up smoking.
• Get a flu vaccine every year in the autumn and a one-off pneumococcal vaccine from your GP.
• Exercise regularly. This helps you breathe more easily by improving your muscle strength and tone and helps improve mucus clearance from the airways. Ask your physiotherapist about this if you have any questions.
• Eat a well-balanced diet and drink plenty of fluids. Minimise caffeinated drinks.