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Bronchiectasis: Causes, Symptoms, Diagnosis And Treatment

A chronic condition where the walls of the bronchi are thickened from inflammation and infection is known as bronchiectasis [1] . People with this condition experience frequent and periodic flare-ups of breathing difficulties.

This condition usually occurs when there is irreversible damage that affects the bronchi (a part of the respiratory system) [2] . The person suffering from this condition can have a persistent cough and will find it difficult to remove sputum.

Bronchiectasis can occur due to a medical condition or as a result of an infection that damages the lungs (leading to an inability to remove mucus). When the mucus keeps collecting in the lungs, it leads to further infections and more damage.

Although common in women over the age of 60 years, it can occur at any age [3] . Read on to know more about this condition.

What Is Bronchiectasis?

Bronchiectasis is a serious condition and if not treated, it can lead to respiratory failure or heart failure. However, with early diagnosis and treatment, the symptoms of this condition can be managed and worsening of the condition can be prevented.

In this condition, the bronchial tubes of the lungs are completely damaged, thickened and widened [1] . The damaged air passages allow bacteria and mucus to build up and pool in the lungs. This leads to frequent infections and blockages of the airways.

Although there is no cure for this condition, it can be managed. It should be noted that flare-ups need to be managed quickly and efficiently to maintain oxygen flow to the rest of the body [4] .

Causes Of Bronchiectasis

Any form of lung injury can lead to bronchiectasis. The primary two categories of this condition are:

  • CF bronchiectasis: This is related to having cystic fibrosis (CF) [5] . A genetic condition that causes abnormal production of mucus.
  • Non-CF bronchiectasis: This is not related to CF. The most common conditions leading to non-CF bronchiectasis are [6] :
  • autoimmune diseases
  • an abnormally functioning immune system
  • inflammatory bowel disease
  • chronic obstructive pulmonary diseases
  • HIV
  • allergic aspergillosis
  • whooping cough
  • tuberculosis

When CF affects the lungs, it results in repeated infections, whereas when it affects other organs, it causes poor functioning.

Symptoms Of Bronchiectasis

The most common symptoms of bronchiectasis are as follows [7] :

  • Shortness of breath that gets worse during exacerbations
  • Coughing up mucus that is yellow or green in colour
  • Feeling extremely tired
  • Fever or chills

  • Wheezing
  • Coughing up blood
  • Chest pain
  • Weight loss
  • Frequent respiratory infections

Diagnosis Of Bronchiectasis

The initial examination begins by your doctor checking your lungs to check for any abnormal sounds or to determine the blockage of airways [1] . You will also need to undergo a complete blood test to look for infection and anaemia. The other tests done include the following:

  • Sputum test: This is done to check the mucus for microorganisms such as fungi, bacteria or viruses [8] .
  • Chest X-ray: This is done to obtain the images of the lungs.

  • Pulmonary function tests: This test determines how well air is flowing into the lungs [9] .
  • Sweat test: This test is used for screening of CF.
  • Purified protein derivative (PPD): This is a skin test that checks for tuberculosis [10] .

Treatment For Bronchiectasis

Although there is no cure for this condition, treatment is important to help one manage these conditions. The idea behind seeking quick treatment is to keep infections and bronchial secretions under control.

The following are some of the commonly followed treatment methodologies [11] :

  • Pulmonary rehabilitation: This involves health education and learning of breathing techniques for people with lung issues [12] .
  • Oxygen therapy: This includes provision of supplemental oxygen to people with breathing difficulties [13] .
  • Methods for clearing the airways: These involve breathing exercises and chest physiotherapy
  • Antibiotics to treat the infection: Doctors can prescribe antibiotics for chest infections.
  • Bronchodilators: Airways can be opened up using albuterol and tiotropium [14] .
  • Medications that can thin the mucus
  • Vaccinations to prevent respiratory infections
  • Expectorants to aid in coughing up mucus

In severe cases, chest physiotherapy becomes necessary. Here, a high-frequency chest wall oscillation vest is used to clear the lungs of mucus. The vest compresses and releases the chest. This creates an effect quite similar to coughing. Hence, the mucus gets dislodged from the walls of the bronchial tubes.

If there is bleeding in the lung, a part of the damaged region might need to be removed through surgery. Another treatment procedure involves draining of the bronchial secretions. A respiratory therapist can teach you various techniques that can help you cough up the excess mucus.

Risk Factors For Bronchiectasis

The following are some of the risk factors for this condition [15] :

  • Chronic or severe lung infections that damage the airways (such as tuberculosis)
  • Absent CFTR protein in bronchial cells in cystic fibrosis
  • Having a whole-body or systemic disease that is associated with bronchiectasis

Complications Of Bronchiectasis

The complications of this condition include the following [16] :

  • Bleeding in the lungs
  • Respiratory failure
  • Heart failure due to low oxygen levels
  • Repeated infections
  • Collapsed lungs

Prevention Of Bronchiectasis

Avoiding smoking, cooking fumes, chemicals and polluted air can help one protect the lungs and maintain good lung health. All children must be vaccinated against pertussis, measles and flu. However, if the exact cause is unknown, prevention can get equally difficult. Therefore, early recognition of this condition is important so that medical intervention can begin before there is any significant lung damage.

View Article References
  1. [1] King P. T. (2009). The pathophysiology of bronchiectasis.International journal of chronic obstructive pulmonary disease,4, 411–419.
  2. [2] Dunnill, M. S., Massarella, G. R., & Anderson, J. A. (1969). A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema.Thorax,24(2), 176-179.
  3. [3] Wallace Jr, R. J., Zhang, Y., Brown, B. A., Dawson, D., Murphy, D. T., Wilson, R., & Griffith, D. E. (1998). Polyclonal Mycobacterium avium complex infections in patients with nodular bronchiectasis.American Journal of Respiratory and Critical Care Medicine,158(4), 1235-1244.
  4. [4] Koser, U., & Hill, A. (2017). What's new in the management of adult bronchiectasis?.F1000Research,6, 527.
  5. [5] Schäfer, J., Griese, M., Chandrasekaran, R., Chotirmall, S. H., & Hartl, D. (2018). Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis.BMC pulmonary medicine,18(1), 79.
  6. [6] Sunny, S. S., Davison, J., & De Soyza, A. (2013). Management of non-cystic fibrosis bronchiectasis.Clinical Practice,10(5), 629.
  7. [7] ten Hacken, N. H., Wijkstra, P. J., & Kerstjens, H. A. (2007). Treatment of bronchiectasis in adults.BMJ (Clinical research ed.),335(7629), 1089–1093.
  8. [8] Lacy, P., Lee, J. L., & Vethanayagam, D. (2005). Sputum analysis in diagnosis and management of obstructive airway diseases.Therapeutics and clinical risk management,1(3), 169–179.
  9. [9] Ranu, H., Wilde, M., & Madden, B. (2011). Pulmonary function tests.The Ulster medical journal,80(2), 84–90.
  10. [10] Yang, H., Kruh-Garcia, N. A., & Dobos, K. M. (2012). Purified protein derivatives of tuberculin--past, present, and future.FEMS immunology and medical microbiology,66(3), 273–280.
  11. [11] Rademacher, J., & Welte, T. (2011). Bronchiectasis--diagnosis and treatment.Deutsches Arzteblatt international,108(48), 809–815.
  12. [12] Patel, S., Cole, A. D., Nolan, C. M., Barker, R. E., Jones, S. E., Kon, S., ... & Man, W. D. (2019). Pulmonary rehabilitation in bronchiectasis: a propensity-matched study.European Respiratory Journal,53(1), 1801264.
  13. [13] Pilcher, J., & Beasley, R. (2015). Acute use of oxygen therapy.Australian prescriber,38(3), 98–100.
  14. [14] Kopsaftis, Z. A., Sulaiman, N. S., Mountain, O. D., Carson-Chahhoud, K. V., Phillips, P. A., & Smith, B. J. (2018). Short-acting bronchodilators for the management of acute exacerbations of chronic obstructive pulmonary disease in the hospital setting: systematic review.Systematic reviews,7(1), 213.
  15. [15] Sly, P. D., & Wainwright, C. E. (2016). Diagnosis and early life risk factors for bronchiectasis in cystic fibrosis: a review.Expert review of respiratory medicine,10(9), 1003-1010.
  16. [16] Kim, C., & Kim, D. G. (2012). Bronchiectasis.Tuberculosis and respiratory diseases,73(5), 249–257.

Story first published: Sunday, June 16, 2019, 9:00 [IST]
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