What is Bronchiectasis

From the British Lung  Foundation.UK Website

What is bronchiectasis?

This information is for people who have bronchiectasis, their families and carers. It explains the causes and symptoms of bronchiectasis, how it is diagnosed and how it is treated.

When you breathe, air is carried into your lungs through your airways. These are a series of tubes, called bronchi.
Your airways contain tiny glands that produce a small amount of mucus. Mucus helps to keep your airways moist and traps the dust and germs that you breathe in. The mucus is then moved away by tiny hairs, called cilia, which line the tubes.

If you have bronchiectasis, your airways become widened and cannot clear themselves properly. This means mucus builds up and the tubes can become infected by bacteria. If bacteria survive in the tubes, they become inflamed, which can further damage your airways. Once the damage has occurred, it is permanent.

The exact number of people who have bronchiectasis is unknown, but some studies suggest there are at least 30,000 people in the UK with the condition.

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What causes bronchiectasis?

Bronchiectasis can occur if your airways become damaged for some reason, causing them to become wider than normal.

It is important to try to find out how your airways have been damaged.
However, in 25 to 50% of all cases the cause is not found. This is known as idiopathic bronchiectasis.
There are some known causes, including:

• severe lung infection, especially during childhood, such as pneumonia, whooping cough or measles;
• underlying inherited disease, such as cystic fibrosis, where the mucus in the airways is too thick, or primary ciliary dyskinesia, where the hairs lining the airways do not work properly;
• lack of immunity to infection, for example a lack of disease-fighting cells called antibodies;
• severe allergic response to fungus (moulds), such as aspergillus, which is often associated with asthma;
• blockage of the airways, for example by items such as peanuts; and
• gastric reflux, when stomach acid travelling up the food tube from the stomach is breathed in.

Bronchiectasis can also be associated with other diseases such as ulcerative colitis or rheumatoid arthritis. It is also sometimes linked with chronic obstructive pulmonary disease (COPD) but the two are separate diseases and it is important to correctly diagnose and treat both.

Symptoms of bronchiectasis

The most common symptom of bronchiectasis is coughing up phlegm, often in large amounts, every day.

People often feel very tired and find it difficult to concentrate. Some people experience shortness of breath or wheeze and may also have problems with their sinuses.
The build-up of mucus in your airways makes your lungs more vulnerable to infection, which can make these symptoms worse. Less common symptoms include coughing up blood, chest pain and joint pain.

Diagnosing bronchiectasis

You or your doctor may suspect bronchiectasis if you have a persistent productive cough where you cough up a lot of phlegm, and regular chest infections.

You will need to have a computerised tomography (CT) scan – sometimes called a CAT scan – to see if your airways are widened and diagnose bronchiectasis. A CT scan is carried out using a special X-ray machine, which produces an image of a cross-section, or slice, of your body.
Your doctor may also ask you to give a sample of your mucus to find out what bacteria are present. You might also need to have tests, such as blood tests, to look for possible causes of bronchiectasis.

Treatment for bronchiectasis

Usually, the damage to your airways that causes bronchiectasis can’t be reversed, so your treatment will help prevent further damage and infections, and reduce your symptoms.

The cause of your bronchiectasis - if it can be found out - should also be treated; for example, you might need antibody replacement if you have low antibody levels.

If you get an infection, it should be treated with antibiotics. Some people who get a lot of infections take continuous antibiotics, either in tablet form or by inhaling them through a nebuliser. It is important that you see your GP if you think you have a chest infection so it can be treated quickly.

Your doctor should refer you to a respiratory physiotherapist, who will teach you various breathing exercises and techniques to help to clear mucus from your lungs. You should then do this yourself regularly.

You might find your symptoms are reduced if you use an inhaler to open up your airways. There are different types of inhaler, including bronchodilators and steroid inhalers.

Some people use treatments to help remove mucus from their airways; these are sometimes called mucus clearance agents. They include hypertonic saline, a salt water solution that can be inhaled into the lungs through a nebuliser and keeps the airways hydrated, and carbocisteine, which makes mucus thinner and less sticky, so it is easier to cough up.

Very occasionally, in cases where bronchiectasis occurs in a single section of the lung, the damaged areas can sometimes be removed with surgery. This is only recommended in a very small number of cases when other treatments have not been successful.

Your doctor will monitor how successful your treatment is, so it can be changed quickly to meet your needs.

For other information

British Lung Foundation BLF.UK

www. Bronchiectasis Foundation.org

www.CHSS.org.uk

Chest, Heart, & Stroke Scotland