When you breathe, the air goes into your lungs through your airways (bronchi). The bronchi divide again and again into thousands of smaller airways (bronchioles). Your airways contain tiny glands that produce a small amount of mucus. Mucus helps to keep your airways moist, and also traps the dust and germs that you breathe in. If you have bronchiectasis, your airways are damaged.
Bronchiectasis is a long-term condition that affects the airways in your lungs. It occurs due to damage to the airways. This causes them to become wider, flabby and scarred. The airways are tubes that carry air in and out of your lungs. The damaged airways are covered with thick mucus— phlegm or sputum.
Due to your airways being wider, it cannot clear sputum properly. This means mucus builds up and infections occur. This leads to repeated, serious lung infections. Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.
Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs. The initial lung damage that leads to bronchiectasis often begins in childhood. However, symptoms may not occur until months or even years after you start having continuous lung infections.
In the United States, common childhood infections such as whooping cough and measles used to cause many cases of bronchiectasis. However, these causes are now less common because of vaccines and antibiotics says the National Heart, Lung and Blood Institute (NHLBI).
What causes bronchiectasis?
For up to half of people diagnosed with bronchiectasis, there’s no clear underlying cause. Bronchiectasis is due to damage to the airway walls. It begins most often in early childhood but can develop at any age. It affects young people more frequently than adults. Common causes include:
- Pneumonia due to viruses such as influenza and measles. Bacteria such as whooping cough or tuberculosis.
- A blockage of your airways, by items such as peanuts
- Inhalation of toxic chemicals
- Damage from another lung conditions such as cystic fibrosis.
- A severe allergic response to fungus or moulds such as aspergillus
- Gastric reflux
- Other diseases such as ulcerative colitis, rheumatoid arthritis and chronic obstructive pulmonary disease (COPD). However, these are separate diseases and it is important to correctly diagnose and treat them individually.
Smoking is not a major cause of bronchiectasis. In fact, many people with the condition have never smoked. However, because smoking is a major irritant to the lungs it will make the condition worse. A problem with how the lungs form in a fetus may cause congenital bronchiectasis. This condition affects infants and children.
What are the symptoms of bronchiectasis?
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. Other people may only occasionally cough up small amounts of phlegm, or none at all.
Other symptoms may include:
- shortness of breath
- coughing up blood or blood-stained phlegm
- chest pain
- joint pain
- clubbing of the fingertips – the tissue beneath the nail thickens and the fingertips become rounded and bulbous
How is bronchiectasis diagnosed?
Your doctor takes a complete medical history. He asks about childhood diseases and recent chest infections. Physical examination which includes listening to the chest. A standard chest x-ray will be recommended and a CT scan of the lungs is essential. This is a painless examination and is similar to an x-ray. Blood and sputum tests are also required. A sputum test is to detect and identify bacteria or fungi that are infecting the lungs or breathing passages.
Treatment of bronchiectasis
Although there is no current cure for bronchiectasis, early treatment is important to help improve how you feel, keep the condition well managed, and maintain normal lung function.
Antibiotics is used to reduce and control the infectious load. A combination of antibiotics may be used depending on the severity of the condition. With good antibiotic management infections cannot recur. For hard-to-treat infections, your doctor may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line inserted into your arm. Your doctor may help you arrange for a home care provider to give you IV antibiotics at home.
Bronchodilators to relax the muscles and open the airways. They are usually breathe in as a fine mist using an inhaler or nebulizer. Inhalation takes the medicine straight into the lungs, for rapid effect.
Expectorants help loosen the mucus in your lungs. They are often combine with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up. Your doctor may prescribe expectorants and mucus thinners to help you cough up mucus.
Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery, which makes it easier to cough up.
Surgery is usually only recommended where bronchiectasis is only affecting a single section of your lung. Also when your symptoms aren’t responding to other treatment and you don’t have an underlying condition that could cause bronchiectasis to recur.
The lungs are made up of sections known as lobes. The left lung has two lobes and the right lung has three lobes. Surgery for focal bronchiectasis would usually involve removing the lobe affected by the bronchiectasis in a type of operation known as a lobectomy.
Surgery won’t be used if more than one lobe is affected, as it’s too dangerous to remove so much lung tissue.
Self-care for bronchiectasis
There are a number of things you can do to help relieve your symptoms. It can also stop the condition getting worse, including:
- Quitting smoking (if you smoke). Because, smoking is a major irritant to your lungs it will make the condition worse.
- Keeping yourself well hydrated. Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. This makes it moist and slippery, which makes it easier to cough up.
- Eating a balanced diet.
People with bronchiectasis are at greater risk of chest infections. You can reduce the chance of getting an infection by:
- Having the flu vaccine every year.
- Exercising regularly. Being physically active helps keep your chest free of infection by helping to clear the mucus. Aim to exercise at least 3 to 4 times per week. Any type of exercise that makes you take long, deep breathes is good. It’s okay if you cough during exercise.
- Having a warm, dry home.