Bronchiectasis

What is bronchiectasis?

In the lining layer of healthy lungs, tiny hairs called cilia work continuously to 'sweep' mucus (sputum/phlegm) up so that it is easily coughed out. With bronchiectasis, these natural cleaning mechanisms have become damaged or destroyed. This inability to clear mucus from the lungs means that there is an increased risk of developing a lung infection. Repeated lung infections can cause further damage to the airway walls. The bronchioles (small breathing tubes) become enlarged and there is usually an excessive amount of mucus produced.

Most people with bronchiectasis have a chronic cough because of the extra mucus being produced. It is a condition that is a lot more common than was previously thought.

What causes it?

Bronchiectasis can be either congenital (existing at birth) or acquired. Congenital bronchiectasis is rare. Sometimes people who have other diseases, such as cystic fibrosis, have difficulty in coughing up mucus and can develop the condition.

The majority of bronchiectasis is acquired, meaning that there has been direct damage or destruction to the bronchial walls. This can be the result of infection, inhalation of noxious chemicals, or damage from another lung condition. Many cases of bronchiectasis begin with pneumonia due to viruses such as influenza and measles, or bacteria such as whooping cough or tuberculosis.

Who gets it?

Bronchiectasis can develop at any age but begins most often in early childhood. The condition usually affects young people more frequently than adults. It is becoming less common as treatment programmes for infection become more effective. A person may have no obvious symptoms for many years and then sometimes, after a respiratory infection, symptoms start and gradually worsen.

Smoking is not a significant cause of bronchiectasis - in fact, many people with the condition have never smoked. However, smoking is a major irritant to the lungs and will seriously aggravate any breathing condition. It is crucial for the person with bronchiectasis to quit/not start smoking and to avoid second-hand smoke.

Between 1986 and 1992, mortality from bronchiectasis in New Zealand exceeded that of asthma and was especially high in Maori aged over 30. This was possibly due to issues of access to health care rather than an increased susceptibility to the condition.

How is it diagnosed?

Your doctor will start by taking a complete medical history, asking about any childhood diseases and any more recent chest infections. He or she will also carry out a physical examination including listening to your 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.

What can be done?

Childhood immunisations, appropriate use of antibiotics, improved living conditions and better nutrition have all helped to reduce the occurrence and the severity of bronchiectasis.
It is essential for infections to be treated early. The airways must be kept as open as possible. If the amount of mucus increases or if there is a change in colour or consistency (very thick mucus) your doctor should be contacted straight away. Treatment may include the use of antibiotics and medicines to open the breathing tubes. Make sure that you receive good information on the correct use of any inhaler you might be prescribed. Your doctor will advise a yearly 'flu vaccine and may recommend a pneumonia shot every 5 or 6 years.
Physiotherapy is an important tool in the management of bronchiectasis. A physiotherapist will be able to show you how to clear your lungs of extra mucus and will provide exercises, which help in draining the lungs and getting mucus up. These exercises can also be done at home.
Regular exercise should be maintained as this will help to strengthen and tone your muscles and will help in clearing mucus from your breathing tubes. Some COPD (Chronic Obstructive Pulmonary Disease) groups have members with bronchiectasis. Contact your local Asthma Society for an exercise group near you.
Good nutrition is important and you should eat a well-balanced diet and drink plenty of fluids.
Quit/don't start smoking and avoid second-hand smoke and other noxious fumes.

What is the outlook for someone with bronchiectasis?

For the most part, bronchiectasis starts from damage to the lungs that is not necessarily ongoing or progressive. Although people with bronchiectasis sometimes fear that in the long term they will become quite debilitated, this is not necessarily the case. With good management, the majority of people will remain stable for many years.

For more information on bronchiectasis

Useful websites include www.lungnet.org.au and www.lunguk.org, or contact your local Asthma Society.

Bibliography

The Australian Lung Foundation, Queensland
British Lung Foundation, London
The Merck Manual Sec. 6, Chap. 70 (website resource)