Bronchiectasis

What is bronchiectasis?

Bronchiectasis is a long-term lung condition where the airways carrying air in and out of your lungs become damaged, widened and scarred. This makes it harder to clear the mucus they produce, which lets bacteria build up and leads to repeated chest infections.

Symptoms of bronchiectasis

• A daily cough, often lasting many weeks
• Coughing up sputum (phlegm), which may be thick, discoloured or bad-smelling
• Shortness of breath and wheezing
• Tiredness and fatigue
• Chest pain, and sometimes joint pain
• Repeated chest infections and colds
• Occasionally, coughing up blood or blood-streaked mucus.

How much this affects you day to day varies a lot. Some people have an occasional cough with only a couple of chest infections a year, while others cough up larger amounts of sputum most days and get infections more often.

Flare-ups

Alongside your usual symptoms, you may have flare-ups, sometimes called exacerbations, where things get worse for a while. Signs of a flare-up include feeling increasingly unwell, your sputum becoming darker, thicker or more plentiful, increased breathlessness, and extra tiredness or lethargy, sometimes with a fever or chills.

Causes of bronchiectasis and who is at risk

Around 4 in 10 cases, no clear cause is ever identified. Where a cause is found, it's usually one of the following:

• A severe lung infection in the past, such as pneumonia, tuberculosis, whooping cough, measles or severe flu
• Another lung condition, such as COPD or asthma
• A weakened immune system, making infections more likely
• Problems with the tiny hair-like structures (cilia) that normally clear mucus from your airways
• Conditions that cause ongoing inflammation, such as rheumatoid arthritis, Crohn's disease or ulcerative colitis
• Stomach acid or food being accidentally breathed into the airways
• An inherited condition such as cystic fibrosis or alpha-1 antitrypsin deficiency
• A blockage in the airway, such as a tumour or an inhaled object.

Bronchiectasis can develop at any age, but it becomes more common the older you get, and it affects women more often than men.

Are there different types of bronchiectasis?

Bronchiectasis is sometimes described by how widespread it is, and sometimes by the shape of the airway damage seen on a scan.

• Focal: damage limited to one area of a lung
• Diffuse: damage spread across many areas of one or both lungs
• Cylindrical: airways are evenly widened, like a smooth tube. This is the most common and generally mildest pattern
• Varicose: airways are wider in some places and narrower in others
• Cystic: honeycomb-like pockets form in the airways. This is the most severe pattern
• Traction: scarring from elsewhere in the lung pulls the airways out of shape.

You may also hear the term non-cystic fibrosis (non-CF) bronchiectasis, used to distinguish bronchiectasis from a different cause to the bronchiectasis that occurs as part of cystic fibrosis, since the two have a different outlook and treatment approach.

How is bronchiectasis diagnosed?

Your doctor will take a detailed history and listen to your chest, then usually arrange a chest CT scan, which is the main test used to confirm bronchiectasis and show how widespread it is. A plain chest X-ray is quicker but often misses all but the most severe cases, so it's mainly used to check for other problems.

You'll usually also have blood tests and a sputum sample sent for testing to check for infection, along with lung function tests to see how well your lungs are working. If an underlying cause hasn't already been identified, further tests, such as a sweat test for cystic fibrosis, genetic testing, or occasionally a bronchoscopy (a thin camera passed into the airways), may help find one.

How is bronchiectasis treated?

There's no cure for bronchiectasis, but a combination of treatments can control symptoms well for most people and help prevent further lung damage. Your care will usually involve your GP alongside respiratory nurses, specialists and physiotherapists.

Airway clearance and rehabilitation

A respiratory physiotherapist can teach you breathing techniques, positioning, and hand-held devices to help clear mucus from your airways. This usually works best done for 20 to 30 minutes once or twice a day, even when you're feeling well, and it's worth sticking with as a daily habit. If breathlessness is limiting your daily activities, you may also be referred for pulmonary rehabilitation, a structured 6 to 8 week programme of exercise and education.

Medication

• Antibiotics to treat chest infections, as tablets, through a drip, or occasionally inhaled for long-term prevention
• Bronchodilator inhalers, to relax and open the airways and ease breathlessness
• Mucolytics or expectorants, to thin mucus and make it easier to cough up
• Macrolide antibiotics, which can also reduce airway inflammation over the long term
• Brensocatib, a newer medicine for people with frequent flare-ups who don't have cystic fibrosis, which works by reducing airway inflammation.

If you keep getting frequent chest infections, your doctor may suggest regular preventive antibiotics, either as short, repeated courses, a low daily dose, or a nebulised (inhaled mist) antibiotic.

Oxygen therapy and surgery

If bronchiectasis is widespread and affects your oxygen levels, you may be offered oxygen therapy at home. Surgery is rarely used and is only really an option if the damage is limited to one small area, or for serious bleeding that hasn't settled with other treatment.

Managing chest infections

Contact your GP promptly if your cough or breathlessness gets worse, your sputum becomes darker or thicker, or you generally feel unwell with a fever or extra tiredness. They'll usually take a sputum sample and prescribe a course of antibiotics, commonly for around 2 weeks. Keep taking them for the full course and get back in touch with your GP if you don't start to feel better within 48 hours.

Looking after yourself day to day

Staying up to date with your flu, COVID-19 and pneumococcal vaccinations, avoiding cigarette smoke and air pollution where you can, keeping active, eating well, and drinking plenty of fluids can all help reduce how often you get chest infections.

When should I see a doctor?

Contact your healthcare provider if you notice signs of infection such as fever or chills, if you're more breathless or tired than usual, if you're losing weight without trying, if you've lost your appetite, or if your mucus becomes heavier, bloodier, or more discoloured.

Get emergency help if you're coughing up a lot of blood, have chest pain, or are struggling to breathe.