Bronchiectasis

Download a Printable Version (.PDF)

What Causes Bronchiectasis? 
What are the Symptoms of Bronchiectasis?
How is Bronchiectasis Diagnosed? 
How is Bronchiectasis Treated?

   Bronchiectasis is a condition of the lungs where the airways (bronchial tubes or windpipes) become inflamed, widened and enlarged so that lung secretions and mucus do not pass out of the airways normally and instead can pool in the lung leading to infection.  This can lead to cough, recurrent bronchial infections, and production of large volumes of sputum.

• What Causes Bronchiectasis?
     There are a large number of diseases which can cause bronchiectasis and your physician may recommend tests to look for some of these underlying diseases.  Cystic fibrosis is a common cause of bronchiectasis in children and lung adults, however, cystic fibrosis occasionally is not diagnosed until adulthood or even on occasion middle age. Immunodeficiencies (low levels of antibodies in the blood) can cause bronchiectasis due to recurrent infection due to low antibody levels.  Previous bouts of pneumonia or tuberculosis can cause bronchiectasis.  Certain uncommon diseases like MAI (mycobacterium avium intracellularae) or ABPA (allergic bronchopulmonary aspergillosis), longstanding aspiration or gastroesophageal reflux, abnormalities in the cilia (hair like projections on the lung lining cells) can all cause bronchiectasis. Alpha-1 antitrypsin deficiency is a cause of emphysema that can sometimes cause bronchiectasis instead.  Unfortunately, in any one patient, the specific cause of bronchiectasis often cannot be determined.

• What are the Symptoms of Bronchiectasis?
     The most common symptoms of bronchiectasis are cough with sputum production.  Although cough without sputum can occur in some patients with bronchiectasis, most patients produce large quantities (up to a quarter cup or more of sputum per day).  Patients often get repeated infections and will be diagnosed with frequent bronchitis and/or frequent pneumonias before eventually arriving at the diagnosis of bronchiectasis years later.

• How is Bronchiectasis Diagnosed?
     Bronchiectasis is often diagnosed just by your physician taking a complete history and physical.  A chest xray can be helpful but a high resolution chest CT scan is the gold standard by which to diagnose this particular condition.  In some cases, a bronchoscopy to look inside your bronchial tubes, can be helpful.  In the past, bronchograms were done to diagnose bronchiectasis but these are rarely done anymore since CT scans are much easier and safer.

• How is Bronchiectasis Treated?
     Once diagnosed with bronchiectasis, the best treatment is to correct the underlying cause for the disease.  In most patients this won't be possible so there are certain things that you can do which will reduce the frequency of infections.  By reducing the frequency of infections, you can slow the progression of the bronchiectasis or even keep it stable.  Reducing the frequency of infections is a major goal in the treatment of bronchiectasis.  A Pneumovax (pneumonia vaccine) is usually given every 5-6 years to prevent a common form of pneumonia and bronchitis.  An influenza vaccine (flu shot) is given every fall to prevent influenza which frequently turns into pneumonia in patients with bronchiectasis.  Most patients are given antibiotics when their sputum increases in volume, their cough increases, or their sputum becomes colored (yellow, green, or gray).  
     A major goal in treating bronchiectasis is to bring up the sputum so that it does not pool in the lungs and become infected.  There are several things you can do to help raise the sputum and get it out of the lungs.  Percussion and postural drainage is performed by tapping or slapping the back to help loose secretions and can be taught by a respiratory therapist to family members or friends.  A flutter valve is a small device which has a ball bearing which vibrates when you blow out causing the air within your windpipes to vibrate and therefore loosen secretions.  This is a very good option for patients who are unable to perform percussion and postural drainage or even as an addition to percussion and postural drainage.
     When the lungs become infected, outpatient treatment with oral or inhaled antibiotics are often sufficient.  However, for severe cases or for infections by difficult to treat bacteria, (such as Staph, or Pseudomonas), treatment with intravenous antibiotics may be required.  This no longer requires the patient to be in the hospital as intravenous antibiotics can be given in the home by a visiting nurse in most cases.
     Because most patients with bronchiectasis will have some bronchospasm, bronchodilators (such as Atrovent, or albuterol) can be very useful.  Some patients will further require treatment with steroids (either oral corticosteroids or inhaled steroids) to further reduce inflammation of the airways.  Surgical removal of the part of involved by bronchiectasis is a last resort option for very specific cases.

Although bronchiectasis is a permanent condition, with proper preventive care, most patients can enjoy a high quality of life with minimal impairment by the underlying bronchiectasis.