Bronchiectasis

What causes bronchiectasis?

Doctors don't fully understand what causes bronchiectasis. The widened airways and higher infection risk may be linked to:

• past infections, such as pneumonia or whooping cough
• problems with the immune system, the body's defence against infection
• long-term lung conditions such as COPD
• allergic bronchopulmonary aspergillosis (ABPA), which happens if you breathe in spores from a fungus you're allergic to

In most cases, no clear cause can be found. This is called idiopathic bronchiectasis.

Your GP may:

• Ask about your symptoms
• Ask whether you smoke
• Listen to your lungs with a stethoscope (in bronchiectasis, the lungs often make a distinctive crackling sound)
• Send you for an X-ray to rule out other conditions

If your GP suspects a lung infection, they may take a sample of your mucus to check it for bacteria.

Referral to a specialist

If your GP thinks you may have bronchiectasis, they will refer you to a specialist in lung conditions for further tests. These may include:

• A CT scan, to see whether your airways have widened or to look for signs of a long standing infection
• Blood tests, to check how well your immune system is working
• A mucus (sputum) test, to check for bacteria or fungi
• A throat swab, to look for viruses
• A genetic screening test, where a sample of blood or saliva is checked for the faulty gene that causes cystic fibrosis
• A lung function test, to measure how hard and how quickly you can blow air out of your lungs, so as to see how well they are working
• A bronchoscopy, in which a flexible tube with a camera is passed into your lungs to look for anything unusual and to take samples from the airways if a long standing infection is suspected

Bronchiectasis causes permanent damage to the lungs, but treatment can ease your symptoms and stop things from getting worse. The main treatments include:

• exercises and special devices to help clear mucus out of your lungs
• medication to help improve airflow in the lungs
• antibiotics to treat any lung infections

You should also:

• stop smoking, if you smoke
• get the flu vaccine every year
• make sure you've had the pneumococcal vaccine to protect against pneumonia
• make sure you've had the coronavirus (COVID-19) vaccine
• exercise regularly
• stay well hydrated
• aim for a healthy weight

Surgery for bronchiectasis is rare. It's only considered if other treatments haven't worked, the damage is limited to one part of the lung, and you're otherwise healthy.

Exercises

A number of exercises can help clear mucus from your lungs. These are called airway clearance techniques, and they can ease coughing and breathlessness. A physiotherapist can teach you these techniques.

One method, called the active cycle of breathing techniques (ACBT), involves repeating a cycle of steps: a period of normal breathing, followed by deep breaths to loosen the mucus and bring it up, then coughing the mucus out. This cycle is repeated for 20 to 30 minutes.

Don't attempt ACBT unless a physiotherapist has taught you the steps first, since doing it incorrectly could damage your lungs.

If you're otherwise healthy, you'll probably only need to do ACBT once or twice a day. If you develop a lung infection, you may need to do it more often.

Changing your position, known as postural drainage, can also make it easier to bring mucus up. This is usually done with help from a physiotherapist or carer.

Devices

Handheld devices can also help remove mucus from your lungs, usually by combining vibration with air pressure to make coughing it out easier. Examples include the Flutter, the RC Cornet, the Acapella and the Aerobika. You may need to pay for one of these yourself.

Medication

In some cases, you may be prescribed medication to make breathing or clearing your lungs easier.

If your symptoms are very severe, you may be prescribed bronchodilators. These are inhaled medications that ease breathing by relaxing the muscles in the lungs. Examples include:

• beta-2 agonists such as salbutamol, terbutaline, formoterol or salmeterol
• antimuscarinics such as tiotropium, glycopyrronium or aclidinium

If your symptoms worsen because of an infection, you'll need antibiotics. If you're well enough to be treated at home, you'll probably be prescribed 2 to 3 antibiotic tablets a day for 14 days. It's important to finish the full course, even once you start feeling better. Recovering fully from a bronchiectasis flare-up can take months.

If your symptoms are more severe, you may need to go to hospital for antibiotic injections. And if you have 3 or more infections in a year, or your symptoms during infection are very severe, you may be given antibiotics on a long-term basis.

Occasionally, medication delivered through a device called a nebuliser may be recommended to make it easier to clear your lungs. A nebuliser has a face mask or mouthpiece, a chamber that turns medication into a fine mist, and a compressor that pumps the medication into your lungs.

Different medications can be given this way. For example, salt water solutions are sometimes used, but only when prescribed by your healthcare professional, to help thin the mucus so it's easier to cough out.

Nebuliser medications are available on prescription. You may have to pay for the device itself, but only if your healthcare professional has advised you to use one.