Bronchiectasis

Bronchiectasis is due to damage to the airways which makes them enlarged. This is mainly because the lining (cilia) of airways are damaged or destroyed. Mucus cannot then be cleared easily from the lung. This allows infection which leads to damage to the airways.

Bronchiectasis usually begins with infection due to viruses such as influenza and measles or bacteria such as whooping cough or tuberculosis. Some people with low immunity, are prone to this condition. Bronchiectasis may also occur in patients who have difficulty coughing up mucus (eg. cystic fibrosis).

Symptoms
Most of the time patients feel well. The main symptom is a cough with sputum. Sputum is often foul smelling causing bad breath and occasionally blood may be coughed up as well. Head colds develop easily into pneumonia and many cases have nose and sinus problems. During times of chest infection, the amount of mucus increases, and moist crackling noises may be heard in the chest.

A cough is usually due to the accumulation of sputum within the breathing tubes and is most effectively treated with regular physiotherapy. Coughing up blood may occur from time to time and usually indicates infection. Coughing up large quantities of blood is frightening although rarely serious. However, medical attention should be sought immediately if this occurs. Patients with bronchiectasis commonly develop chest infections, as a result of minor upper respiratory tract infections such as the common cold should be managed promptly. In patients with advanced bronchiectasis, breathlessness is a common feature particularly during times of infection.

Tests
A chest x-ray may not always show changes suggestive of Bronchiectasis. CT scans are sometimes needed to make the diagnosis and to show which part of the lung is involved. Sputum tests may be helpful in identifying which bugs are causing infection and allow for a sensible choice of antibiotic. Your specialist will arrange breathing tests from time to time to help monitor the progress of your condition.

Treatment
The aim of treatment is to clear mucus from the chest. In the majority of cases, symptoms can be very effectively treated with physiotherapy and exercise programs. An individual program can be developed with a physiotherapist and may include physical exercise, postural drainage of the chest, active breathing, huffing, coughing or other physiotherapy techniques. Exercise can be combined with the inhalation of a bronchodilator – a medicine which helps to open up the airways.

Antibiotic treatment is usually required which sometimes needs to be given in the hospital. Bronchodilator medicines can be helpful. Adults with bronchiectasis should also be encouraged to have a vaccination against influenza each year and against pneumococcal pneumonia where appropriate.

Patients with severe disease can develop breathlessness and low exercise tolerance but the majority remain stable for many years. Cases with cystic fibrosis often have more severe Bronchiectasis. Physiotherapy and exercise programs improve the quality of life and reduce the number of episodes of infection and hospital admissions. Regular review by your specialist and prompt antibiotic therapy should be considered.

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