Bronchiectasis

Symptoms of Bronchiectasis

The most common symptoms of bronchiectasis are:

• Coughing up a lot of mucus
• Shortness of breath
• Feeling run down or tired
• Fevers or chills

These symptoms are often worse during flare-ups.

Other symptoms include:

• A wheezing or a whistling sound while you breathe
• Coughing up blood or mucus mixed with blood, a condition called hemoptysis
• Chest pain from increased effort to breathe
• Thickening of skin under nails, known as clubbing

Causes of Bronchiectasis

There are two kinds of bronchiectasis: cystic fibrosis (CF) bronchiectasis and non-CF bronchiectasis. Between one-third and one-half of bronchiectasis cases in the United States are associated with CF.

Bronchiectasis is often a part of diseases that affect the whole body. Non-CF bronchiectasis can develop from:

• Low levels of infection-fighting proteins in the blood (This is known as humoral immunodeficiency.)
• Recurring or long-term infections, such as tuberculosis or nontuberculous mycobacteria (NTM)
• Inflammatory bowel disease, including Crohn disease and ulcerative colitis
• Rheumatologic diseases, including rheumatoid arthritis and Sjögren disease
• Alpha1-antitrypsin deficiency (This is the genetic cause of chronic obstructive pulmonary disease or COPD in some people.)
• COPD
• Asthma
• Immune system weaknesses, such as human immunodeficiency virus (HIV) or uncontrolled diabetes
• An allergic lung inflammation that causes airway swelling
• When a person inhales food, liquids, saliva, or stomach acids into the lungs repeatedly
• Damage to the hair-like structures lining the airway, making them not work properly (This is known as primary ciliary dyskinesia.)
• Something people are born with (or congenital)

What are the risk factors for Bronchiectasis?

The most common risk factors for bronchiectasis are:

• Being diagnosed with CF
• Having a long-term inflammatory lung disease
• Long-term or severe lung infections (such as tuberculosis)

Diagnosing Bronchiectasis

Health care providers may use various tests to diagnose bronchiectasis. These tests include:

• Blood tests. They check for:
  • Conditions associated with bronchiectasis
  • Infection
  • Low levels of infection-fighting blood cells
• Chest computed tomography (CT or “CAT”) scan or X-ray. A CT scan can show the location of lung damage. It can also show abnormal thickness and irregular airways.
• Mucus (sputum) culture. This checks for bacteria or other microbes.
• Lung function tests. These tests measure how much air you are able to inhale and exhale.
• Bronchoscopy. A flexible, narrow tube (known as a bronchoscope) is inserted into your airways to help find blockages and infection and inflammation.

Treating Bronchiectasis

Common medications

The three goals of bronchiectasis treatment are to:

• Fight infections
• Help make mucus thinner and easier to clear from the lungs.
• Open the airways

There are many options for treating bronchiectasis. Your health care provider will help determine the best one, or a combination, for you. Generally, medications fall into three categories:

• Antibiotics
• Macrolides
• Mucolytics

Antibiotics

Antibiotics are typically the first line of attack against infections. Based on the severity of your infection, your provider will give you antibiotics that you either take by mouth or receive through your veins (intravenously). Some antibiotics can be inhaled using a hand-held device called a nebulizer. It converts the medicine into a mist.

Macrolides

Macrolides are a type of antibiotic that not only kill certain types of bacteria but also reduce inflammation in the airways. Azithromycin and clarithromycin are examples of macrolides. They are sometimes used over several months. This may be beneficial for some people. However, these medications may have serious side effects, including:

• Diarrhea
• Nausea
• Hearing loss
• Dizziness
• Development of resistant bacteria in the lungs

Mucus-thinning medication

Mucus-thinning medications, known as mucolytics, help people with bronchiectasis get mucus out of their lungs. A nebulizer turns the medicine into a mist. The mist is inhaled deep into the lungs.

Medicine given through a nebulizer helps to break up mucus in the airways. The mucus then can be coughed up more easily.

Nebulizers

Nebulizers turn medication into a mist that you can breathe into your lungs. There are three basic parts:

• The nebulizer cup that holds the medicine
• A machine that converts the medicine into a mist
• A mask or mouthpiece for breathing in the mist

Nebulizers are small and quiet. It usually takes from 8 to 10 minutes to receive a full dose of medicine.

Airway clearance devices and methods

Some people use devices to clear out mucus. Some of these devices require you to exhale into a hand-held device, for example. This causes air to enter the airway, helping to break up mucus. Other devices are wearable, like a vest. They shake the chest to help loosen mucus. Talk to your provider about whether any of the following devices are right for you:

• Acapella®
• AerobiKa®
• Flutter®

Oscillating Positive Expiratory Pressure (PEP)

To use a PEP, you blow into a portable handheld PEP device. It contains a small ball that moves up and down. This creates vibrations in the lungs. The vibrations help release mucus. That makes it easier to cough the mucus out of the lungs.

Postural drainage

Using this method, gravity helps drain mucus from the lungs. You lie with your head and chest facing down. This can be effective along with percussion and/or vibration.

Oxygen therapy

Some people with bronchiectasis may need supplemental oxygen. This can:

• Make your breathing easier
• Enhance your quality of life
• Help you live longer

Oxygen therapy also improves sleep, mood, and mental alertness. It helps the body with everyday functions and it can help prevent heart failure.

There are three types of oxygen:

• Compressed gas oxygen in steel or aluminum containers of different sizes for home use and traveling
• Liquid oxygen that changes into a breathable gas
• Oxygen concentrators, electrical devices that remove nitrogen from the air

If your health care provider prescribes oxygen, be sure to ask about:

• The oxygen flow rate or setting, so you receive the right amount
• When you should wear it—during activity, while sleeping, or all the time
• Which type best suits your lifestyle

Chest physical therapy

Chest physical therapy includes a variety of physical methods for loosening mucus from the lungs so that it can be coughed out. The typical methods used for bronchiectasis include:

• Chest percussion. This is controlled tapping or clapping on the body. Clapping is most common. A percussive vest can be a convenient and portable option. It automatically tightens then loosens around the chest.
• Controlled coughing. This is often used with chest percussion. This kind of coughing provides a way to loosen mucus to be pushed out of the lungs.

Surgery

Bronchoscopy

Sometimes, people get a blockage in the airway. This could lead to severe lung damage. To remove the blockage, you may need a bronchoscopy. A bronchoscope, a long thin tube with a light and camera at the end, is inserted either through the mouth or nose. It examines and removes whatever is in the airway.

Lung surgery

Lung surgery is usually the last treatment option that people try. In cases where lung damage and serious symptoms don’t respond to other treatments, surgery may involve:

• Removal of part or all of a single lung (This is an option when only one lung is severely damaged, or only one lung has a severe infection that does not improve with antibiotics.)
• Embolization (This stops bleeding when a lot of blood is being coughed up.)
• Lung transplantation

Living with Bronchiectasis

Bronchiectasis is a long-term disease. It usually develops slowly over time. It can never be cured. However, it is possible to slow the progress and preserve lung function. Effective management is possible when self-care is part of your daily routine. To care for yourself, do these things:

• Take your medications as directed. Follow all instructions your provider gives you.
• Clear your mucus.
• Eat balanced, healthy meals.
• Stay hydrated. Drink plenty of water and liquids.

Exercise and nutrition

One of the best ways to manage bronchiectasis is by taking care of your overall health. You can manage your overall health through both exercise and nutrition. If you have questions about exercise, ask your health care provider about exercise plans that might be best for you.

Nutrition is also important. It is recommended that people with bronchiectasis meet with a nutritionist. A nutritionist can help you improve your diet and maintain a healthy weight.

Hydration

Drinking lots of fluids, especially water, helps keep mucus thin and easier to clear from the body.

Immunizations

Typically, the seasonal flu vaccine and pneumococcal vaccine are recommended for those with bronchiectasis.

Pulmonary rehabilitation

Your provider may suggest a program that can help you with exercise, education, and support. It can improve your exercise abilities and quality of life. It also may reduce flare-ups.
 

Get the facts about Bronchiectasis: Myths BUSTED

Bronchiectasis Myths Busted

Resources

There are several online support groups. They can be found through a simple Internet search. The American Lung Association’s Living with Lung Disease Support Community connects patients and caregivers with others who have this disease.

You can call the American Lung Association’s Lung Helpline at 1-800-LUNGUSA. A trained lung professional can answer your questions and connect you with support.

If you have CF, visit the Cystic Fibrosis Foundation website.

Questions to ask your health care provider

If you have bronchiectasis, get regular checkups. Making notes before your visits and taking a family member or friend can help. The following are questions you can ask your provider to better understand this disease:

• Why did I get this disease?
• Is it contagious?
• Is my type of bronchiectasis genetic?
• How often should I provide a mucus sample?
• What are the signs and symptoms of a flare-up?
• What should I do when I have a flare-up?
• What can I do to prevent a flare-up?
• What vaccinations should I have to prevent lung infections?
• What if medications don’t help me, even though I take them as directed?
• Should I take an over-the-counter cough and cold product?
• What can help with the emotional challenges of having lung disease?
• What can I do to improve my lung condition?
• What type of exercise might help?
• What changes should I make to my diet?
• Are there support groups?