What is Bronchiectasis?

Bronchiectasis is among a group of lung diseases classified as chronic obstructive pulmonary disease, or COPD. The disease is marked by an abnormal widening and thickening of the large airways (bronchi) of the lungs as a result of chronic inflammation and/or infection. When the airways thicken, excess mucus pools in the widened areas, leading to infection and airway obstruction. Normally, cilia – tiny hair-like structures that line airways – gently sweep back and forth to aid in the process of mucus clearance. In bronchiectasis, however, the cilia are destroyed making mucus clearance much more difficult. This leads to repeated cycles of inflammation, infection and airway obstruction typical of bronchiectasis.^[1]

Although bronchiectasis is irreversible, with treatment, symptoms can be managed and most people can live relatively normal lives.^[2]

Causes

Bronchiectasis is caused by a number of conditions including:²

• Genetic diseases that are present at birth such as cystic fibrosis and primary ciliary dyskinesia.
• Deficiencies in the immune system leading to reduced ability to fight infections.
• Childhood lung infections
• Impaired ability to swallow leading to aspiration of fluids or food into the lungs.

Many times, the cause of bronchiectasis is unknown. These cases are coined “idiopathic” bronchiectasis.²

Symptoms

The most common symptom of bronchiectasis is a productive cough, meaning it brings up mucus or sputum. The cough may worsen at times, especially at night. It may be accompanied by fever, chills, night sweats, fatigue and a change in the color and consistency of mucus. When symptoms worsen like this, it’s referred to as an “exacerbation,” otherwise known as a flare-up, of bronchiectasis. Other symptoms may include:²

• Shortness of breath
• Unintentional weight loss
• Coughing up blood (hemoptysis)
• Pain or tightness in the chest

Symptoms of bronchiectasis usually develop, and worsen, over time.

Diagnosis

Bronchiectasis is sometimes difficult to diagnose because symptoms of the disease mimic those of other illnesses, such as chronic bronchitis or pneumonia. The first step in making an accurate diagnosis, however, begins with a visit to the doctor for a thorough history and physical examination. Tests that may be ordered to assist your doctor in correctly diagnosing this disease include:^[3]

• Chest X-ray
• Chest computed topography (CT) scan
• Pulmonary function tests
• Bronchoscopy

Treatment

Goals of treatment for bronchiectasis are to control infection, promote drainage of excess mucus from the airways and prevent further complications. If you’re seeking treatment for bronchiectasis, your doctor may order any of the following medications:¹

• Antibiotics – commonly used to treat bacterial infections associated with bronchiectasis. If prescribed antibiotics, be sure to take the complete course of medication as stopping before the bottle is finished can lead to return of your symptoms and antibiotic resistance.
• Macrolides – this type of antibiotic only kills certain types of bacteria but also reduces redness and swelling in the airways. Macrolides, such as azithromycin, erythromycin and clarithromycin, are sometimes given prophylactically, meaning on a daily basis for a long period of time to help prevent infection. While some people may benefit from prophylactic treatment, others may suffer terrible side effects such as nausea, diarrhea, dizziness, hearing loss and the development of resistant bacteria in the lungs. Talk to your doctor to determine whether macrolide treatment is right for you.
• Mucolytics – this type of medication is given to thin mucus in the airways so it’s easier to cough up. Mucolytics are usually given through a nebulizer, where they are mixed with hypertonic saline, reduced to a fine mist and then inhaled deeply into the lungs.
• Mucus clearance devices – some patients benefit from devices that help clear mucus from the airways. Some devices — such as the Lung Flute — require the patient to exhale into the mouthpiece of the device causing air to flutter in the bronchi, which purportedly helps loosen mucus. Others wear a vest that gently shakes the chest to loosen mucus. If a mucus-clearing device is right for you, your doctor will help you choose the right one.

Prevention

Immediate treatment of lung infections may help some people prevent bronchiectasis. Self-care plays an important part of living with the disease and you can help prevent the characteristic recurrent infections that come with the disease by:^[4]

• Quitting smoking – if you’re a smoker, cigarette smoke damages the airways even further. It’s best to quit immediately to help prevent further complications.
• Avoiding all other airway irritants – such as secondhand smoke, air pollution or fumes from harsh chemicals in the workplace. Long-term exposure to airway irritants causes further lung damage that may lead to complications.
• Getting vaccinated – an annual flu shot, the pneumonia vaccine where applicable and other vaccines that your doctor recommends can help prevent infection that may worsen lung damage that comes with bronchiectasis.
• Frequently washing your hands – frequent handwashing, when done correctly, is one of the best ways to prevent infection. Using soap and warm water, scrub your hands, wrists and under your fingernails for at least 20 seconds. Grab a clean hand towel or paper towel to turn off water and then dry your hands.

For more information about bronchiectasis, talk to your primary care provider.

_{[1] American Lung Association. Bronchiectasis. Accessed March 27, 2018.}

_{[2] American Thoracic Society. Patient Information Series: What is Bronchiectasis? Accessed March 27, 2018.}

_{[3] Eldridge, Lynne, MD. What is Bronchiectasis? Last updated November 18, 2016.}

_{[4] Smeltzer, Suzanne C. & Bare, Brenda, G. (1996). Brunnuer and Suddarth’s Testbook of Medical-Surgical Nursing (8th Edition). Pennsylvania, PA: Lipponcott-Raven Publishers.}