Bronchiectasis

Bronchiectasis is a long-term condition in which the airways of the lungs become abnormally widened. This leads to a build-up of mucus (phlegm), and that can raise the risk of infection.

Anyone can get bronchiectasis, at any age, but symptoms don't usually show up until middle age.

The most common symptoms of bronchiectasis are:

• a persistent cough that usually brings up mucus
• recurrent chest infections
• fatigue

Symptoms can differ from one person to the next. They tend to get worse if you have an infection in your lungs.

Phone a doctor or the 16263 health line if you have bronchiectasis and any of these:

• a bluish tinge to the skin and lips
• confusion
• a high temperature of 38°C (100.4F) or above
• rapid breathing (more than 25 breaths a minute)
• severe chest pain that makes it too painful to cough and clear your lungs

• you've had a cough for more than 3 weeks

Your doctor may:

• ask you about your symptoms
• ask whether you smoke
• listen to your lungs with a stethoscope (the lungs of people with bronchiectasis often make a distinctive crackling noise)
• send you for an X-ray to rule out other conditions

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

If your doctor thinks you may have bronchiectasis, they'll send you to a specialist in lung conditions for further tests. These may include:

• a CT scan, to see if your airways have widened or to look for any signs of chronic 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, which shows how well they're working
• bronchoscopy, where a flexible tube with a camera is used to look into your lungs for anything abnormal, and to take samples from the airways if a chronic infection is suspected

The damage that bronchiectasis does to the lungs is permanent. But treatment can ease your 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

You should also:

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

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

If you have bronchiectasis, some exercises can help clear mucus from your lungs. They're called airway clearance techniques, and they can often ease coughing and breathlessness.

A doctor can refer you to a physiotherapist, who will teach you these techniques.

Active cycle of breathing techniques (ACBT) means repeating a cycle of steps. First you breathe normally for a while. Then you take deep breaths to loosen the mucus and push it up. After that, you cough the mucus out. You repeat the cycle for 20 to 30 minutes.

Don't try ACBT until a physiotherapist has taught you the steps. Doing it the wrong way could damage your lungs.

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

Changing your position can also make it easier to clear mucus from your lungs. This is called postural drainage. A physiotherapist or carer usually helps you with the steps.

There are also small handheld devices that can help clear mucus from your lungs when you have bronchiectasis. Most of them work by using vibrations and air pressure together, which makes it easier to cough the mucus out.

The Flutter, the RC cornet, the Acapella and the Aerobika are some examples.

You may have to pay for one yourself.

Sometimes a doctor prescribes medicines to make breathing easier or to help clear your lungs when you have bronchiectasis.

If your symptoms are very severe, you may be given bronchodilator medicines. These are breathed in, and they help you breathe more easily by relaxing the muscles in the lungs. Examples include:

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

If your symptoms are getting worse because of an infection, you'll need antibiotics. If you're well enough to be treated at home, you'll probably be given 2 to 3 antibiotic tablets a day for 14 days. Finish the whole course even if you feel better. Recovering fully from a bronchiectasis exacerbation can take months.

If your symptoms are more severe, you may need to go to hospital for antibiotic injections.

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.

Now and then, a medicine breathed in through a device called a nebuliser may be recommended, because it makes it easier to clear your lungs. A nebuliser has:

• a face mask or mouthpiece
• a chamber to change medicine into a fine mist
• a compressor to pump the medicine into your lungs

Different medicines can be given through a nebuliser. Salt water solutions are one example, and you should use them only if your doctor has prescribed them. They reduce the thickness of your mucus, so it's easier to cough out.

Doctors don't fully understand what causes bronchiectasis. The airways become widened and the risk of infection goes up, and this can be linked to:

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

In most people with bronchiectasis, no clear cause can be found. This is known as idiopathic bronchiectasis.