What is bronchiectasis?

Pronounced bron-key-eck-ta-sis, this long-term condition affects the airways in your lungs. If you have bronchiectasis, you will usually have a persistent cough that produces mucus, plus you may also find it difficult to catch your breath. It’s also likely you’ll be more susceptible than usual to getting lung infections that make your symptoms even worse.
 
Bronchiectasis is named after the bronchi, which are the airways in your lungs. These bronchi are the tubes that branch off your windpipe that split into smaller branches called bronchioles. The bronchioles, in turn, split into tiny sacs called alveoli. It is through these airways that the oxygen you breathe in travels, eventually being absorbed into your bloodstream via the alveoli.      
 
If you have bronchiectasis, your airways become gradually bigger or wider than they should be. Meanwhile, the insides of your bronchi and bronchioles are coated with mucus, which means we all have some mucus in our lungs. However this is a good thing, because any harmful particles you might breathe in get trapped in the mucus and are then cleared out of your lungs by coughing or swallowing (your stomach acid destroys them).

However, when your airways are bigger or wider than normal, there is a tendency for an increased amount of mucus. This results in frequent coughing and the explusion of mucus. It also makes your airways more vulnerable to chest infections. And if you do develop a chest infection it could damage your airways further, making even more mucus gather in them. Over time this vicious cycle can lead to worsening damage to your lungs, with the airways becoming increasingly inflamed and prone to collapse.
 

Bronchiectasis types

 
Not all cases of bronchiectasis are the same. In some only a part of a lung may be affected – this is called focal bronchiectasis. If the problem is more widespread throughout the lungs, however, the medical term is diffuse bronchiectasis.
 
There are also three main forms of bronchiectasis – though you may have one, two or three of them at the same time:
 

• Cylindrical bronchiectasis is thought to be the most common form (it’s also considered the least serious) (i). With this form, the bronchi become enlarged and cylindrical

• Varicose bronchiectasis is where the bronchi become irregular in size and shape, with some areas becoming wider and others more narrow

• Cystic bronchiectasis is the most severe form (ii), where dilated bronchi form clusters of cysts (it’s also the form that’s often found in people with cystic fibrosis). Cystic bronchiectasis is sometimes called saccular bronchiectasis

 

How common is bronchiectasis?

 
Bronchiectasis can affect both adults and children. According to the charity Asthma + Lung UK around one in 200 adults in the UK has bronchiectasis, 60 percent of whom are aged 70 years or older (iii). Slightly more women are affected than men – according to the National Institute of Health and Care Excellence (NICE) a 2013 study found 5.6 per 1,000 women had bronchiectasis compared to 4.9 per 1,000 men (iv). Another 2019 study suggests that of the 211,598 people in the UK living with bronchiectasis at the time of publication, 4,638 were children (v).
 

Risk factors of bronchiectasis

 
Things that increase your risk for developing bronchiectasis include having a chronic lung condition such as asthma or chronic obstructive pulmonary disease (COPD) and your age (since the condition is more common in older people). Meanwhile, NICE reports that studies have suggested up to a quarter of people diagnosed with the COPD might actually have bronchiectasis (iv).
 

Bronchiectasis symptoms

 
Besides a persistent cough with mucus and shortness of breath, some of the other symptoms that affect people with bronchiectasis include:
 

• Wheezing

• Chest pain

• Joint pain

• Coughing up blood

• Clubbed fingertips (rounded and bulbous fingertips caused by a thickening of the tissue under the nails)

 
When your symptoms are particularly bad – known as a flare-up or exacerbation – you may also experience additional symptoms such as fatigue, a high temperature, chills and night sweats.
 

Bronchiectasis exacerbation

 
An exacerbation may be caused by a lung infection (this is known as an infective exacerbation). When this happens it can cause worsening shortness of breath, feelings of extreme tiredness, sharp pains in your chest when you breathe (pleurisy), unpleasant smelling mucus and a general feeling of being unwell. According to NICE, approximately half of those with bronchiectasis will have two exacerbations per year (vi).
 
If you have bronchiectasis and experience these symptoms, don’t put off seeing your GP as you may need treatment for a lung infection. However if you haven’t been diagnosed with bronchiectasis and develop a chronic cough, see your doctor for advice, as persistent coughing always needs to be investigated.
 

Bronchiectasis life expectancy

 
The good news is that if you have mild bronchiectasis your life expectancy should be normal, with treatments keeping most people reasonably well. But in a small number of cases the condition can become gradually worse, and on very rare occasions bronchiectasis can cause a life-threatening bleed as a result of the airways being badly damaged.
 
 

What causes bronchiectasis?

 
In about 50 per cent of bronchiectasis cases in adults there’s no obvious reason why the airways become widened and damaged (vi). When there is an identifiable cause, it’s usually an infection or another condition.
 
When your immune system detects a harmful substance such as bacteria or a virus in your airways, it reacts by sending chemicals to the area to fight the infection. These chemicals cause inflammation, and for most of us the inflammation passes when the infection clears up without causing any problems. However, in some individuals, the inflammation destroys tissues and muscles around the bronchi, making the bronchi bigger and wider. Further infections make the situation worse. While bronchiectasis can progress rapidly in some, for many, it develops slowly over time.
 

Bronchiectasis and lung disease

 
Around one in three cases of bronchiectasis in adults are linked with a severe lung infection during childhood (vi), with infections in general thought to cause up to 42 per cent of cases overall (vii). Measles, flu, whooping cough, tuberculosis (TB) and pneumonia are some of the infections that, even when they affect you as a child, can cause bronchiectasis when you’re an adult. Thankfully vaccinations are available for these particular infections, with the NHS suggesting childhood infections may, as a result, become a less common cause of bronchiectasis in the future.
 
Meanwhile some of the conditions that have been associated with bronchiectasis include:
 

Cystic fibrosis

In this genetic disorder, thick mucus clogs the digestive system and the airways, making breathing difficult and infections more likely. Around 9,000 people in the UK are thought to be living with cystic fibrosis, with one in 2,500 babies in the UK born with the condition every year (viii). Indeed cystic fibrosis and bronchiectasis have similar symptoms. However their treatments and outlooks are different.
 

Allergic bronchopulmonary aspergillosis

ABPA is a rare allergy to a type of fungi called aspergillus that lives in many environments around the world. If you have ABPA and breathe in aspergillus spores, you will usually experience an allergic reaction. The inflammation this causes can lead to bronchiectasis.
 

Autoimmune conditions

Certain conditions that are thought to be a result of the immune system mistakenly attacking healthy tissue and causing inflammation – such as rheumatoid arthritis, Sjögren's syndrome, ulcerative colitis and Crohn’s disease – have also been linked with bronchiectasis.
 

Kartagener’s syndrome

 
Several rare conditions such as Kartagener’s syndrome, alpha-1 antitrypsin deficiency, yellow nail syndrome plus congenital defects of the large airways such as Young’s syndrome are thought to cause bronchiectasis too. Problems with the immune system – including HIV infection – have also been linked with it, as has a blood clot in the lungs called a pulmonary embolus.
 
Another thing that has been linked with the development of bronchiectasis is called gastric aspiration. This is the term doctors use when small pieces of food are accidentally inhaled into the lungs rather than travelling down normally into the digestive system. This can cause inflammation in the lungs, which can trigger bronchiectasis. According to experts, gastric aspiration causes up to four percent of bronchiectasis cases (vii).
 

Are there any complications?

If bronchiectasis is severe it can cause respiratory failure, which is potentially life-threatening. Very rarely it can also cause a very serious complication called massive haemoptysis, which is when you cough up large amounts of blood (this happens when one of the blood vessels in the lungs splits).

Symptoms of massive haemoptysis include coughing up more than 100ml of blood in 24 hours, difficulties with breathing and feeling lightheaded and dizzy with cold, clammy skin. If you think you – or someone else – may be experiencing massive haemoptysis, call 999 for an ambulance straight away.

Bronchiectasis treatment      

If you see your GP with the possible symptoms of bronchiectasis you’ll usually be referred to a specialist in respiratory conditions. This specialist may suggest a number of different tests to find out how severely your lungs are affected and also to find out if there is an underlying condition that’s causing your symptoms.
 
Once diagnosed, your specialist will recommend treatment to stop your condition from progressing and your symptoms from getting worse. This often includes a combination of medication, exercises called airway clearance techniques, and devices that help clear mucus from your lungs:
 

Medication 

 
Some of the medicines used to treat bronchiectasis include antibiotics, which are used when you have a lung infection. Some people who have three or more infective exacerbations in a year or particularly severe infections may need to take antibiotics as a preventative treatment on a long-term basis – though milder cases may only need antibiotics for 10 or 14 days when needed. If you have to take long-term antibiotics you’ll usually be monitored to check that you’re not developing antibiotic resistance.
 
Other medicines used to treat bronchiectasis include those that aim to help you breathe or clear your lungs more easily. Drugs called bronchodilators, for instance, are often recommended on a short-term basis for severe exacerbations (these help relax the muscles in your lungs). Some other medicines may be delivered via a nebuliser, which is a device that emits medicine as a fine list that’s directed into your lungs.
 

Lung clearance exercises 

 
 If you have bronchiectasis your specialist may refer you to a physiotherapist to teach you how to do airway clearance technique exercises . These help improve coughing and breathlessness by removing mucus from your lungs. These techniques include:
 

• Active cycle of breathing techniques (ACBT) has three parts – first you breathe normally, then you breathe deeply with each breath held for a few seconds; this is followed by huffing, where you contract your stomach muscles to force air out of your lungs (imagine breathing on a mirror to mist it up). You should only attempt this if you’ve been taught the technique by a physio, as if you don’t do it correctly you can do more harm than good.

• Postural drainage is another technique, but this time it involves changing your position to make it easier for mucus to be removed from your lungs. These positions are usually leaning or lying positions in which you have to remain for at least 10 minutes. This technique is quite complicated, and again shouldn’t be attempted without the help of a  physio.

 

Medical devices

 
Several hand-held devices – such as the Acapella – are designed to help clear mucus from the lungs. Most of them work in a similar way, using air pressure and air vibrations to loosen mucus and make it easier to cough out. These devices aren’t always available on the NHS, however – though you can buy them privately.
 
Meanwhile surgery isn’t routinely recommended for bronchiectasis, but you may be advised to have an operation called a lobectomy that removes part of the lung affected by bronchiectasis if only one part (lobe) of your lung is affected, if other treatments aren’t effective and if you don’t have an underlying condition causing your bronchiectasis.
 

Can bronchiectasis be prevented?

Since around half of bronchiectasis cases have no known cause it’s not always possible to take steps to prevent it developing. However there are a couple of ways to help cut down your risk, including:
 
• Getting vaccinated against infections that can cause bronchiectasis (including an annual flu jab)
 
• Treating infections quickly (your doctor will usually prescribe antibiotics for respiratory infections)
 
If you’re a smoker giving up may also be helpful – indeed, if you develop bronchiectasis your specialist will usually advise you to stop smoking straight away, as smoking can make your symptoms worse (passive smoking should also be avoided).
 

Living with bronchiectasis

 
Managing bronchiectasis includes following a healthy, balanced diet. Eating healthily can help make sure you’re getting the nutrients your body – and your immune system – needs, plus it can help you to maintain a healthy weight (this can be beneficial because being overweight may make you feel more breathless while being underweight may increase your risk of developing infections (ix)).
 
If you don’t always eat as healthily as you should, you may want to invest in a good-quality multivitamin and mineral supplement to make sure you meet your nutritional needs on a daily basis. If you’re not sure which multivitamin would suit you best, read our guide to multivitamins and daily requirements. 
 
Another supplement that may be useful is a high-strength fish oil formula, since the omega-3 fatty acids found in oily fish are thought to help reduce inflammation. For example, a study published in the journal Nutrients concludes that omega-3 fatty acids sourced from oily fish may be useful in disorders with an inflammatory component (x).
 
Also remember to keep drinking plenty of water, as not only can this keep you well hydrated but it can also help keep your mucus from becoming too thick, which means you can clear it from your lungs more easily.
 

Bronchiectasis exercises

 
Meanwhile exercise may be difficult if you have bronchiectasis, especially when you’re feeling short of breath. However gentle activities that make you slightly breathless such as walking and swimming can actually be very helpful, as they can help clear mucus from your chest and improve your fitness overall (staying fit can also help boost your immune system, which improves your resistance to infections).
 
If you’re not sure which types of exercises would be best for you, speak to your specialist or physiotherapist.
 
It’s also important to try and avoid infections whenever you can. So as well as keeping up to date with your vaccines, try to avoid being around people with colds and chest infections, and if you can’t avoid being around others remember to wash your hands frequently.
 
Getting the right amount of sleep will also help, as it can keep your energy levels up. However there will be times when, despite all your best efforts, you’ll feel tired. When that happens, try to rest and relax as much as possible, and save energetic tasks for when you have more stamina.
 

• Taking steps to reduce the stress in your life may also be a good idea. Why not try some of the suggestions in our guide to stress symptoms and signs?

 

Need more info?

 
If you’re looking for more information about respiratory health and conditions, try the respiratory sectionof our pharmacy health library

References:

1. N/A, Bronchiectasis. Cleveland Clinic. N/A. Available online: https://my.clevelandclinic.org/health/diseases/21144-bronchiectasis

2. N/A, Bronchiectasis - Professional Reference. Patient.info. N/A. Available online: https://patient.info/doctor/bronchiectasis-pro

3. N/A, What is Bronchiectasis? What Causes It? Asthma UK. N/A. Available online: https://www.asthmaandlung.org.uk/conditions/bronchiectasis/what-bronchiectasis-what-causes-it

4. N/A, Bronchiectasis - Background Information. Clinical Knowledge Summaries (CKS). N/A. Available online: https://cks.nice.org.uk/topics/bronchiectasis/background-information/prevalence/

5. Snell N et al., Epidemiology of bronchiectasis in the UK: Findings from the British lung foundation’s ‘Respiratory health of the nation’ project. Respir Med. 2019 Oct-Nov;158:21-23. Available online: https://www.resmedjournal.com/article/S0954-6111(19)30299-9/fulltext

6. N/A, Bronchiectasis - Prognosis and Complications. Clinical Knowledge Summaries (CKS). N/A. Available online: https://cks.nice.org.uk/topics/bronchiectasis/background-information/prognosis-complications/

7. N/A, Bronchiectasis - Causes. NHS. N/A. Available online: https://www.nhs.uk/conditions/bronchiectasis/causes/

8. N/A, Bronchiectasis - Professional Reference. Patient.info. N/A. Available online: https://patient.info/doctor/bronchiectasis-pro

9. N/A, Cystic Fibrosis - Patient Information Leaflet. Patient.info. N/A. Available online: https://patient.info/chest-lungs/cystic-fibrosis-leaflet#nav-4

10. N/A, Self-Management of Bronchiectasis. Asthma UK. N/A. Available online: https://www.asthmaandlung.org.uk/conditions/bronchiectasis/self-management-bronchiectasis

11. Calder PC, Omega-3 Fatty Acids and Inflammatory Processes. Nutrients. 2010 Mar;2(3):355-374. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/

Related Posts

 

Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

---