Bronchiectasis (brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to dilate, floppy and scar. The airways are tubes that carry air in and out of your lungs.

Bronchiectasis usually results from an infection or other condition that damages the walls of your airways or prevents the airways from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria and other small particles.

With bronchiectasis, your airways slowly lose their ability to clear mucus. When mucus cannot be removed, it accumulates and creates an environment for bacteria to grow. This leads to repeated, serious lung infections.

Any infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from getting into your vital organs.

Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis) and heart failure.

Overview

Bronchiectasis can affect just one section of one of your lungs or multiple sections of both lungs.

The initial lung damage leading to bronchiectasis often starts in childhood. However, symptoms may not appear until months or even years after repeated lung infections.

In the United States, common childhood infections - such as whooping cough and measles - have caused many cases of bronchiectasis. However, these causes are now less common due to vaccines and antibiotics.

Now bronchiectasis usually results from a medical condition that damages the airway walls or prevents the airways from clearing mucus. Examples of such conditions are cystic fibrosis and primary ciliary (SIL-e-ar-e) dyskinesia (dis-kih-NE-ze-ah) or PCD.

Bronchiectasis that affects only part of the lung can be caused by a blockage rather than a medical condition.

Bronchiectasis can be congenital (kon-JEN-ih-tal) or acquired. Congenital bronchiectasis affects infants and children. It is the result of a problem with how the lungs form in a fetus.

Acquired bronchiectasis occurs as a result of some other condition or factor. This type of bronchiectasis can affect adults and older children. Acquired bronchiectasis are more common than the congenital type.

Symptoms

The initial airway damage that leads to bronchiectasis often starts in childhood. However, signs and symptoms may not appear until months or even years after you start getting repeated lung infections.

The most common signs and symptoms of bronchiectasis are:

• A daily cough that occurs over months or years
• Daily production of large amounts of sputum (spit). Sputum, which you cough up and spit out, can contain mucus (a slimy substance), trapped particles and pus.
• Shortness of breath and wheezing (a whistling sound when breathing)
• Chestpain
• Clubbing (the flesh under your fingernails and toenails thickens)

If your doctor listens to your lungs with a stethoscope, he or she may hear abnormal lung sounds.

Over time, you can develop more serious symptoms. You may cough up blood or bloody mucus and feel very tired. Children may lose weight or not grow normally.

Bronchiectasis Complications

Severe bronchiectasis can lead to other serious health problems, such as respiratory failure and atelectasis.

Respiratory failure is a condition in which not enough oxygen flows from your lungs to your blood. The condition can also occur if your lungs cannot properly remove carbon dioxide (a waste gas) from your blood.

Respiratory failure can cause shortness of breath, rapid breathing, and hunger for air (the feeling that you cannot breathe in enough air). In severe cases, signs and symptoms may include a bluish color on your skin, lips and fingernails; confusion; and drowsiness.

Atelectasis is a condition in which one or more parts of your lungs collapse or are not inflated properly. As a result, you may feel short of breath. Your heart rate and breathing may increase, and your skin and lips may turn blue.

As bronchiectasIf you are so advanced that it affects all parts of your airways, it can cause heart failure. Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs.

The most common signs and symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins on the neck.

Therapy

Bronchiectasis is often treated with medications, hydration, and chest physiotherapy (CPT). Your doctor may recommend surgery if the bronchiectasis is isolated to part of the lung or if you are bleeding a lot.

If the bronchiectasis is widespread and causes respiratory failure, your doctor may recommend oxygen therapy.

The goals of the treatment are:

• Treat any underlying conditions and lung infections.
• Remove mucus (a slimy substance) from your lungs. Maintaining good hydration helps get rid of mucus.
• Avoid complications.

Early diagnosis and treatment of the underlying cause of bronchiectasis can help prevent further lung damage.

In addition, any disease related to the bronchiectasis, such as cystic fibrosis or immunodeficiency should also be treated.

Medicines

Your doctor may prescribe antibiotics, bronchodilators, expectorants, or expectorant medicines to treat bronchiectasis.

Antibiotics

Antibiotics are the main treatment for the recurrent lung infections that cause bronchiectasis. Oral antibiotics are often used to treat these infections.

For difficult-to-treat infections, your doctor may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line that is inserted into your arm. Your doctor can help arrange for a home care provider to give you IV antibiotics at home.

Expectorants and expectorant medicines

Your doctor can prescribe expectorants and expectorants to help you cough up phlegm.

Expectorants help loosen the mucus in your lungs. They are often combined with decongestants, which can provide additional relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make coughing easier.

For some of these treatments, little information is available to show how well they work.

Hydration

Drinking plenty of fluids, especially water, helps prevent the mucus in the airways from becoming thick and sticky. Good hydration helps keep mucus in the airways moist and smooth, making it easier to cough up.

Physiotherapy on the chest

CPT is also referred to as physiotherapy (FIZ-eo-THER-ah-pe) or chest slaps or percussion. This technique is usually performed by a respiratory therapist, but it can also be done by a trained family member. It involves the therapist hitting your chest and back with his or her hands or a device over and over again. Doing this will loosen mucus from your lungs so you can cough it up.

You can sit with your head tilted down or lie on your stomach with your head down while doing CPT. Gravity and force help to clear mucus from your lungs.

Some people find CPT difficult or uncomfortable to do. Several devices can help with CPT, such as:

• An electric chest clapper, known as a mechanical percussor.
• An inflatable therapy vest that uses high-frequency air waves to force mucus into your upper airways so you can cough it up.
• A small handy device through which you exhale. It causes vibrations that loosen the mucus.
• A mask that creates vibrations to help break down mucus from your airway walls.

Some of these methods and devices are popular with patients and doctors, but little information is available about how well they actually work. The choice is usually based on convenience and cost.

Various breathing techniques are also used to move mucus to the upper airways so that it can be coughed up. These techniques include forced expiration technique (FET) and active cycle breathing (ACB).

FET means that you inhale a few times and then breathe relaxed. ACB is FET that involves deep breathing exercises.

Other treatments

Depending on your condition, your doctor may also provide a bronchodilator

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