Learn About Bronchiectasis
Bronchiectasis is a chronic lung condition in which the walls of the airways are abnormally enlarged and thickened from inflammation and infection. Bronchiectasis literally means “dilated airways” (“bronchi-” meaning the airways of the lungs, and “-ectasis” meaning enlargement or dilatation of an organ). Because the airway walls are damaged, it is difficult for mucus to leave the body. Over time, the increase in mucus buildup can lead to infection, which once again may damage the airway walls. A cycle of inflammation and infection can develop, ultimately leading to loss of lung function over time.
In bronchiectasis, lung function gradually declines over years. But the good news is that by catching inflammations and infections early, you can slow the process down. Click on our guide, “Living Well With Bronchiectasis” to learn more about the condition.
This patient education guide, infographic, and other collateral pieces are generously supported by Bayer.
- More than 110,000 people in the United States have been diagnosed with bronchiectasis.
- While this lung condition occurs in people of all ages, the prevalence of bronchiectasis increases with age. Fewer than 1 out of 20,000 people ages 18 to 34 have the disease compared with 1 out of 350 people by age 75.
- Medical expenditures for bronchiectasis are estimated to be $630 million annually.
- Bronchiectasis occurs more in women than in men.
- Treatment is aimed at clearing mucus, preventing infections, and reducing inflammation.
What Is Bronchiectasis
Bronchiectasis happens when the walls of the airways, known as bronchi, thicken or enlarge as a result of chronic inflammation and/or repeated infections, which cause an increase in mucus accumulation. Mucus is the body’s way of clearing out particles that get into the lungs. In a normal lung, there are little hair-like structures, known as cilia, on the bronchi that sweep mucus and particles up and out of the lungs. But in people with bronchiectasis, the cilia are destroyed so mucus and particles can’t be expelled from the lungs. As a result, mucus builds up in the lung, which attracts bacteria and microbes that lead to infection. Chronic infections lead to chronic inflammation, which causes additional thickening and widening of the airways. Over time, the thickened airways can make it harder to breathe.
The Chronic Cycle of Bronchiectasis
- Because of repeated infections, airways lose the ability to process mucus out of the lungs.
- Mucus builds up, which attracts bacteria and microbes.
- The bacteria multiply and cause additional lung infections and inflammation.
- The new lung infections and inflammation do additional damage to the airways.
- Over time, the enlarged and widened airways make it harder and harder to breathe.
How Bronchiectasis Affects Your Body
Bronchiectasis is a long-term condition that can be treated but never cured. Lung function gradually declines over years.
People with bronchiectasis go through periods of good and bad health. During the bad health times, they experience flare-ups, known as exacerbations, which can last days or weeks and vary in their severity. The sooner patients go to the doctor and begin treatment for the infections, the less damage the infection is likely to cause to the lungs. In addition to medications for infections, there are other preventive measures that can reduce the decline in lung function.
Bronchiectasis Symptoms, Causes, and Risk Factors
What Are the Signs and Symptoms of Bronchiectasis?
The most common symptoms of bronchiectasis are:
- Coughing up large amounts of mucus every day
- Shortness of breath that gets worse during exacerbations
- Feeling run-down or tired, especially during exacerbations
- Fevers and/or chills, usually developing during exacerbations
- Wheezing or a whistling sound while you breathe
- Coughing up blood or mucus mixed with blood, a condition called hemoptysis
- Chest pain associated with increased effort to breathe
- Thickening of the skin under fingernails and toenails, known as clubbing
Causes of Bronchiectasis
There are two categories of bronchiectasis: cystic fibrosis (CF)-bronchiectasis and non-CF bronchiectasis. Between one-third and one-half of the cases of bronchiectasis in the United States are associated with cystic fibrosis.
Bronchiectasis is often part of diseases that affect the whole body. Non-CF bronchiectasis can develop as a result of the following conditions:
- Humoral immunodeficiency, which is characterized by low levels of infection-fighting proteins in the blood
- Recurring or chronic infections, such as tuberculosis or nontuberculous mycobacteria (NTM)
- Inflammatory bowel disease, including Crohn’s disease and ulcerative colitis
- Rheumatologic diseases, including rheumatoid arthritis and Sjögren’s disease
- Alpha1-antitrypsin deficiency, which is the genetic cause of COPD in some people
- Chronic obstructive pulmonary disease or COPD
- Weaknesses in the immune system, such as HIV or uncontrolled diabetes
- Allergic bronchopulmonary aspergillosis, a type of allergic lung inflammation that causes swelling in the airways
- Recurring or chronic pulmonary aspiration, in which a person inhales food, liquids, saliva, or stomach acids into the lungs
- Primary ciliary dyskinesia, where the hair-like structures that line our airway are damaged and don’t work properly
- Congenital, or something people are born with
What Are the Risk Factors?
The most common risk factors for bronchiectasis are:
- Being diagnosed with cystic fibrosis (CF)
- Having a chronic inflammatory lung disease
- Chronic or severe lung infections (such as tuberculosis)
- Recurrent aspirations that chronically damage the lungs
Diagnosing and Treating Bronchiectasis
How Is Bronchiectasis Diagnosed?
Health-care providers may use various tests to diagnose bronchiectasis and help determine the cause. These tests can include:
- Blood tests to check for conditions associated with bronchiectasis and whether you have an infection or low levels of infection-fighting blood cells.
- Chest CT (or CAT) scan and/or x-ray to look at lung structure. A CT scan can show the extent and location of lung damage, as well as the areas with abnormal thickening and irregular airway walls.
- Mucus (sputum) culture to check for growth of bacteria or other microbes.
- Lung function tests to measure your capacity for breathing (eg, how much air you take in, how much air you expel, and how well your lungs are delivering oxygen to your blood).
- Bronchoscopy using a long narrow tube (known as a bronchoscope) inserted into the airways in more severe or resistant cases to detect any blockages and sources of infection and inflammation.
Medications are recommended for bronchiectasis in order to achieve three goals: 1) fight infections, 2) thin mucus so it can more easily be expelled from the lungs, and 3) use bronchodilators to open the airways.
There are many different medications that can be used to help combat bronchiectasis. Your doctor will select the most appropriate medication or combination of medications based on your condition and health status. Generally, these medications fall into three categories:
Treating bronchiectasis with antibiotics is typically the first line of attack to eliminate the bacteria that leads to infections. Depending on the severity of your condition, your doctor will decide whether you should be treated with antibiotics that you take by mouth or with antibiotics that are given through the veins (intravenously). Some antibiotics can be inhaled using a hand-held device, called a nebulizer, that converts the medicine into a mist.
Macrolides are a type of antibiotic that not only kill certain types of bacteria but also reduce inflammation in the bronchi. Examples of macrolides include azithromycin and clarithromycin. Sometimes macrolides are given for long-term use over several months. This may be beneficial for some people but also may come with serious side effects, like diarrhea, nausea, hearing loss, dizziness, and the development of resistant bacteria in the lungs. You should discuss with your health-care provider whether the use of macrolides is appropriate for you.
Mucus-thinning medications, known as mucolytics, help people with bronchiectasis get mucus out of their lungs. They are often given through a nebulizer, where the medicine is turned into a mist and inhaled deep into the lungs. The medication given through the nebulizer helps to dissolve mucus in the bronchi so that it can be coughed up more easily. In cases of bronchiectasis caused by cystic fibrosis, another inhaled mucus thinning medication may be prescribed.
Airway Clearance Devices
Some patients use devices to clear out mucus. Some of these devices have the patient exhale into a handheld device that causes air to flutter in the bronchi, which helps break up the mucus. Other devices are wearable, like a vest, and shake the chest to help loosen mucus. Talk to your doctor about whether or not any of these devices are right for you.
- Oscillating Positive Expiratory Pressure (PEP): PEP devices stimulate vibrations in the lungs that release secretions that have attached to the walls of the airways, making it possible to cough them out of the lungs. By blowing into these portable hand-held devices, you move a small ball contained in the device up and down, which creates the vibration.
- Intrapulmonary Percussive Ventilation (IPV): Another type of oscillating device is the IPV device, which is a pressurized aerosol machine that turns medications into a mist that can enter the body through a The mist is inhaled under pressure and with oscillations that vibrate the chest and loosen airway secretions.
- Postural Drainage: Postural drainage uses gravity to help drain secretions from the lungs. A patient lies in a variety of positions with the head and chest in a downward position. This can be an effective technique to pair with percussion and/or vibration to help get mucus out of the lungs and out of the body.
Over time, some people with bronchiectasis need to use supplemental oxygen, which can make your breathing easier, enhance quality of life, and may help people live longer. Oxygen is not addictive, meaning increased use won’t make you need it more. Oxygen therapy can:
- Improve sleep, mood, and mental alertness
- Better allow the body to conduct its everyday functions
- Prevent heart failure
There are three types of oxygen:
- Compressed gas oxygen, which comes in steel or aluminum containers in different sizes for home use and traveling.
- Liquid oxygen, which changes liquid into a breathable gas.
- Oxygen concentrators, electrical devices that remove nitrogen from the air, thus concentrating the oxygen.
If your health-care provider prescribes oxygen, be sure to ask about:
- The oxygen flow rate or setting, so you receive the right amount of oxygen per minute of use.
- When you should wear your oxygen, such as during activity, while sleeping or continuously.
- Which type of oxygen equipment best suits your lifestyle needs.
Chest Physical Therapy
Chest physical therapy, also known as chest physiotherapy, stands for a variety of physical techniques for loosening mucus from the lungs so that it can be expelled. The typical techniques used for bronchiectasis include:
- Chest percussion: A process of controlled tapping or clapping on the body in a way that loosens mucus accumulating in the airways. Clapping is the most common manual technique. A percussive vest, which automatically tightens then loosens around the chest, offers a convenient and portable option to achieve the same results.
- Controlled coughing: Often used in conjunction with chest percussion, controlled coughing provides the way for loosened mucus to be expelled out of the lungs.
Bronchoscopy: Sometimes people with bronchiectasis experience a blockage in the airway. Left unchecked, a blockage could lead to severe lung damage. In these cases, you may require a bronchoscopy to remove the obstruction. A bronchoscope, which is a long thin tube with a light and camera at the end, is inserted either through the mouth or nose to examine and remove whatever is lodged in the airway.
Lung Surgery: Lung surgery is generally a last resort in cases where lung damage and/or serious symptoms don’t respond to other treatments. This may include:
- Removal of part or all of a single lung when only one lung is severely damaged or harboring a severe infection that does not improve with antibiotics,
- Embolization, used to stop bleeding in patients who cough up a lot of blood, and
- Lung transplantation.
Living Well with Bronchiectasis
Bronchiectasis is a chronic condition that usually develops slowly over time. While it can never be cured, it is possible to slow the progress and protect lung function through effective management. That is why it is important to incorporate self-care strategies into daily life, including taking oral and inhaled medications, performing mucus clearance techniques, and staying well nourished and hydrated.
What To Expect
Bronchiectasis is a long-term condition with symptoms that need to be managed every day. That includes:
- Taking daily medications to keep airways open and reduce mucus accumulation.
- Taking antibiotics for 2 to 3 weeks during exacerbations.
- Periodic lung function tests, chest x-rays, or CT (CAT) scans.
- Mucus sample collection to check for infection, as needed.
- In severe situations, occasional hospital stays for IV antibiotics, especially if your lungs are infected by difficult-to-treat bacteria or other microbes.
- Possibly bronchoscopy, a procedure performed under sedation by lung doctors (pulmonologists) to directly inspect the bronchi.
Exercise and Nutrition
One of the best ways to manage bronchiectasis is by strengthening your physical fitness. Both exercise and nutrition are important to strengthen your overall health. Your doctor may recommend that you participate in a cardiopulmonary exercise program or an exercise program that can be done at home two to three times per week. Nutrition also serves an important role for maintaining your health. It is recommended that people with bronchiectasis meet with a nutritionist to help them understand how they can improve their diet and maintain a healthy weight.
Drinking lots of fluids, especially water, helps keep mucus thinner and easier for the lungs to process out of the body and is highly recommended for people with bronchiectasis.
Typically, the seasonal influenza vaccine and pneumococcal vaccine are recommended for patients with bronchiectasis.
Pulmonary rehabilitation is a program of exercise, education, and support that can be ordered by your doctor. It may improve your exercise capacity, quality of life, and may reduce flare-ups.
Several bronchiectasis support groups have been organized online and can be found through a simple online search. The American Lung Association recommends patients and caregivers join its Living with Lung Disease Support Community to connect with others facing this disease. You can also call the Lung Association’s Lung Helpline at 1-800-LUNGUSA to talk to a trained respiratory professional who can help answer your questions and connect you with support. If you have cystic fibrosis, you can find support groups and ways to connect by visiting the website for the Cystic Fibrosis Foundation.
Questions to Ask Your Doctor About Bronchiectasis
It is important for patients who have been diagnosed with bronchiectasis to see their doctor for periodic checkups. Making notes before your visits, as well as taking along a trusted family member or friend, can help you through the first appointments with your doctor.
Here are some questions to pose to your doctor during your first visit related to a diagnosis of bronchiectasis:
- Why did I develop this problem?
- Am I contagious?
- Is my type of bronchiectasis genetic?
- How often should I provide a sample of mucus for culture at the laboratory?
- What are the signs and symptoms of an exacerbation?
- What should I do when I experience an exacerbation?
- Is there anything I can do to prevent an exacerbation?
- What vaccinations should I have to prevent pulmonary infections?
- What if the medications you prescribe for me don’t help me feel better, even though I take them as directed?
- Should I take an over-the-counter cough and cold product?
- Can you recommend anything that can help me with the emotional toll of having lung disease?
- Is there anything I can do to improve my lung condition?
- What type of exercise might help?
- What type of nutritional strategies should I follow?
- Are there support groups for bronchiectasis?
Doreen Addrizzo-Harris, MD, FCCP
NYU School of Medicine
Christopher Barrios, MD
Wake Forest Baptist Medical Center
Sheetal Gandotra, MD
Wake Forest Baptist Medical Center
Alex Gifford, MD, FCCP
Geisel School of Medicine at Dartmouth
Malvika Sagar, MBBS
Baylor Scott & White Health
Gilbert Seda, Jr., MD, PhD, FCCP
Naval Medical Center
Date Last Reviewed