Bronchiectasis

Symptoms

The most common symptom of bronchiectasis is a persistent cough that brings up a large amount of phlegm on a daily basis.

The phlegm can be clear, pale yellow or yellow-greenish in colour. Some people may only occasionally cough up small amounts of phlegm, or none at all.

Other symptoms may include:

• shortness of breath
• wheezing
• coughing up blood or bloodstained phlegm
• chest pain
• joint pain
• clubbing of the fingertips – the tissue beneath the nail thickens and the fingertips become rounded and bulbous

Causes

Bronchiectasis is caused by the airways of the lungs becoming damaged and widened. This can be the result of an infection or another condition, but sometimes the cause is not known.

Common causes

In around half of all cases of bronchiectasis, no obvious cause can be found. 

These are some of the more common triggers that have been identified.

Childhood infections

Around 1 in 3 cases of bronchiectasis in adults are associated with a severe lung infection in childhood, such as:

• severe pneumonia
• whooping cough
• tuberculosis (TB)
• measles

But as there are now vaccinations available for these infections, it's expected that childhood infections will become a less common cause of bronchiectasis in the future.

Immunodeficiency

Some cases of bronchiectasis occur because a person has a weakened immune system, which makes their lungs more vulnerable to tissue damage.

The medical term for having a weakened immune system is immunodeficiency.

Some people are born with an immunodeficiency because of problems with the genes they inherit from their parents.

It's also possible to acquire an immunodeficiency after an infection such as HIV.

Allergic bronchopulmonary aspergillosis (ABPA)

Some people with bronchiectasis develop the condition as a complication of an allergic condition known as allergic bronchopulmonary aspergillosis (ABPA).

People with ABPA have an allergy to a type of fungi known as aspergillus, which is found in a wide range of different environments across the world.

If a person with ABPA breathes in fungal spores, it can trigger an allergic reaction and persistent inflammation, which can progress to bronchiectasis.  

Aspiration

Aspiration is the medical term for stomach contents accidentally passing into your lungs, rather than down into your gastrointestinal tract.

The lungs are very sensitive to the presence of foreign objects, such as small samples of food or even stomach acids, so this can trigger inflammation leading to bronchiectasis.

Cystic fibrosis

Cystic fibrosis is a genetic disorder, where the lungs become clogged up with mucus.

The mucus then provides an ideal environment for a bacterial infection to take place, leading to the symptoms of bronchiectasis.

Cilia abnormalities

Cilia are the tiny hair-like structures that line the airways in the lungs. They're designed to protect the airways and help move away any excess mucus.

Bronchiectasis can develop if there's a problem with the cilia that means they're unable to effectively clear mucus from the airways.

Conditions that can cause problems with the cilia include:

• Young's syndrome – a rare condition only affecting males thought to be caused by exposure to mercury in childhood
• primary ciliary dyskinesia – a rare condition caused by inheriting faulty genes

Regulations regarding the use of mercury are now much stricter, so it's expected that Young's syndrome will become a much less common cause of bronchiectasis in the future.

Connective tissue diseases

Certain conditions that cause inflammation in other areas of the body are sometimes associated with bronchiectasis.

These include:

• rheumatoid arthritis
• Sjögren's syndrome
• Crohn's disease
• ulcerative colitis

These conditions are usually thought to be caused by a problem with the immune system, where it mistakenly attacks healthy tissue.

Diagnosis

You should see a GP for advice if you develop a persistent cough so they can look for a possible cause.

The GP will ask you about your symptoms, such as how often you cough, whether you bring up any phlegm (sputum), and whether you smoke.

They may also listen to your lungs with a stethoscope as you breathe in and out. The lungs of people with bronchiectasis often make a distinctive crackling noise as a person breathes in and out.

You'll also probably have a chest X-ray to rule out other, more serious, causes of your symptoms, such as lung cancer.

If the GP thinks you may have a lung infection, they may take a sample of your phlegm so it can be checked for bacteria.

Referral to a specialist

If the GP suspects you could have bronchiectasis, you'll be referred to a doctor who specialises in treating lung conditions (a respiratory consultant) for further testing.

Further testing

HRCT scan

Currently, the most effective test available to diagnose bronchiectasis is called a high-resolution CT (HRCT) scan.

A HRCT scan involves taking several X-rays of your chest at slightly different angles. A computer is then used to put all the images together.

This produces a very detailed picture of the inside of your body, and the airways inside your lungs (the bronchi) should show up very clearly.

In a healthy pair of lungs, the bronchi should become narrower the further they spread into your lungs, in the same way a tree branch separates into narrower branches and twigs.

If the scan shows that a section of airways is actually getting wider, this usually confirms bronchiectasis.

Other tests

Other tests can be used to assess the state of your lungs and to try to determine what the underlying cause of your bronchiectasis may be.

These tests may include:

• blood tests – to check how well your immune system is working and check for infectious agents, such as bacteria, viruses and fungi
• phlegm (sputum) test – to check for bacteria or fungi
• a sample of your sweat can be tested to see how much salt is in it – high levels of salt can be caused by cystic fibrosis (if this test is positive, a more detailed genetic test can be carried out)
• lung function test – a small, handheld device (a spirometer) that you blow into is used to measure how hard and how quickly you can expel air from your lungs; this can assess how well your lungs are working
• bronchoscopy – a flexible tube with a camera at one end is used to look into your lungs; this is usually only required if you think you have inhaled a foreign object

Treatment Options

The damage caused to the lungs by bronchiectasis is permanent, but treatment can help relieve symptoms and stop the damage getting worse.

The main treatments include:

• exercises and special devices to help you clear mucus out of your lungs
• medicine to help improve airflow within the lungs
• antibiotics to treat any lung infections that develop

Surgery is usually only considered for bronchiectasis in rare cases where other treatments have not been effective, the damage to your bronchi is confined to a small area, and you're in good general health.

Complications

Complications of bronchiectasis are rare, but they can be serious.

One of the most serious complications is coughing up large amounts of blood, caused by one of the blood vessels in the lungs splitting.

This can be life-threatening and may require emergency surgery to treat it.

When To See A Doctor

You should see a GP if you develop a persistent cough. While this may not be caused by bronchiectasis, it requires further investigation.

If the GP suspects you may have bronchiectasis, they'll refer you to a specialist in treating lung conditions (a respiratory consultant) for further tests.