Bronchiectasis: Causes, Symptoms and Treatment

What is Bronchiectasis?

Bronchiectasis is a chronic and irreversible condition in which the bronchi – the airways of the lungs – become abnormally widened, scarred, and thickened. The damaged airway walls lose their ability to clear mucus effectively, leading to a cycle of mucus accumulation, bacterial colonisation, chronic inflammation, and repeated lung infections. Over time, this cycle causes further airway damage and progressive loss of lung function.

Causes

Bronchiectasis can result from a variety of underlying conditions and can be either congenital (present from birth) or acquired later in life:

• Respiratory infections: Severe or repeated pneumonia, tuberculosis, whooping cough, or other lower respiratory tract infections can permanently damage the airway walls.
• Cystic Fibrosis: One of the most common genetic causes, characterised by abnormally thick mucus that obstructs and damages the airways.
• Primary Ciliary Dyskinesia (PCD): An inherited disorder affecting the tiny hair-like structures (cilia) that normally clear mucus from the airways.
• Immune deficiencies: A weakened immune system increases susceptibility to recurrent infections that damage the bronchi.
• Autoimmune conditions: Diseases such as rheumatoid arthritis or inflammatory bowel disease are associated with bronchiectasis.
• Aspiration: Inhaling foreign objects or gastric contents can cause localised airway damage.
• Idiopathic: In many cases, no clear underlying cause can be identified.

Symptoms

The symptoms of bronchiectasis vary depending on the severity of the condition. Common signs and symptoms include:

• Chronic cough – often persistent over months or years
• Excess mucus production – frequently thick, yellow or green sputum
• Recurrent chest infections – bronchitis or pneumonia
• Breathlessness – particularly during physical activity
• Coughing up blood (haemoptysis) – possible in advanced stages
• Fatigue and general malaise
• Clubbing of the fingers – a sign of chronic lung disease characterised by enlarged fingertips

Diagnosis

The diagnosis of bronchiectasis is established through a combination of clinical assessment and investigations:

• High-Resolution Computed Tomography (HRCT): This is the gold-standard imaging technique for diagnosing bronchiectasis, clearly demonstrating the characteristic widening of the airways.
• Pulmonary function tests (spirometry): Used to assess breathing capacity and degree of airflow obstruction.
• Sputum culture: Analysis of coughed-up mucus to identify causative bacteria and guide antibiotic therapy.
• Blood tests: To assess inflammatory markers and immune function.
• Bronchoscopy: Direct visualisation of the airways may be used in selected cases.

Treatment

While bronchiectasis cannot be cured – as the structural changes to the airway walls are permanent – treatment aims to reduce symptoms, prevent infections, and slow disease progression.

Airway Clearance Techniques

Regular chest physiotherapy and airway clearance techniques are a cornerstone of management. Methods such as active cycle of breathing techniques (ACBT), autogenic drainage, and oscillating positive expiratory pressure (PEP) devices help to loosen and mobilise mucus from the airways.

Medical Treatment

• Antibiotics: Used during acute exacerbations (flare-ups) or for long-term suppression in patients with chronic bacterial colonisation, particularly with Pseudomonas aeruginosa. Antibiotics may be given orally, intravenously, or via inhalation.
• Bronchodilators: Inhaled medications that widen the airways and ease breathing.
• Mucolytics: Agents that reduce the thickness of mucus, making it easier to clear.
• Inhaled corticosteroids: May be used in patients with a coexisting asthmatic component or significant airway inflammation.

Treating the Underlying Cause

Where a specific underlying condition is identified (e.g. cystic fibrosis, immune deficiency), targeted treatment of that condition is essential to prevent further airway damage.

Vaccinations

Annual influenza vaccination and pneumococcal vaccination are strongly recommended to reduce the risk of serious respiratory infections.

Surgical Treatment

In rare cases where bronchiectasis is localised to a single area of the lung and symptoms are severe, surgical resection of the affected lung segment may be considered. Lung transplantation may be an option in patients with end-stage disease.

Prognosis and Outlook

The outlook for individuals with bronchiectasis varies widely. With consistent adherence to airway clearance techniques and appropriate medical management, many people can significantly improve their quality of life and reduce the frequency of infective exacerbations. Without adequate treatment, the condition may progress, leading to increasing respiratory impairment.

References

1. Polverino E. et al. – European Respiratory Society guidelines for the management of adult bronchiectasis. European Respiratory Journal, 2017; 50(3): 1700629.
2. Chalmers J.D. et al. – Bronchiectasis. Nature Reviews Disease Primers, 2018; 4: 45.
3. British Thoracic Society (BTS) – Guideline for non-CF Bronchiectasis. Thorax, 2010; 65 (Suppl 1): i1-i58.