What Is Bronchiectasis?
Bronchiectasis (bron-kee-ek'-tas-is) is
a lung disease that usually results from an infection or other condition that
injures the walls of the airways in your lungs. The airways are the tubes that
carry air in and out of your lungs.
This injury is the beginning of a cycle
in which your airways slowly lose their ability to clear out mucus. The mucus
builds up and creates an environment in which bacteria can grow. This leads to
repeated serious lung infections. Each infection causes more damage to your
airways.
Over time, your airways become
stretched out, flabby, and scarred. They can no longer move air in and out.
This can affect how much oxygen reaches
your body organs. If your lungs cannot move enough oxygen into your body,
bronchiectasis can lead to serious illness, including
heart
failure.
Bronchiectasis can affect just one
section of one of your lungs or many sections of both lungs.
Bronchiectasis usually begins in
childhood, but symptoms may not appear until months or even years after you
have started having repeated lung infections.
There are two types of
bronchiectasis:
- Congenital bronchiectasis usually affects infants
and children. It results from a problem in the development of the lungs in the
fetus.
- Acquired bronchiectasis occurs in adults and
older children. It is more common.
Bronchiectasis cannot be cured, but
with proper care, most people who have it can enjoy a good quality of life.
Other Names for Bronchiectasis
- Acquired bronchiectasis
- Congenital bronchiectasis
What Causes Bronchiectasis?
Bronchiectasis is caused by injury to the lower
airways. This injury may be caused by another disease, including:
- Cystic fibrosis, which leads to almost half of
the cases of bronchiectasis in the United States.
- Severe pneumonia.
- Whooping cough (uncommon because most people are
now vaccinated against it).
- Tuberculosis (TB) and other similar
infections.
- Immunodeficiency disorders, such as HIV infection
and AIDS.
- Allergic bronchopulmonary aspergillosis, an
allergic reaction to a fungus called aspergillus that causes swelling in the
airways.
- Kartagener's Syndrome, a rare inherited disease
that involves the cilia (sil'-ee-ah). These are small hair-like structures that
line your airways and normally clear out mucus.
- Other disorders that affect the function of the
cilia.
Other conditions that can injure the lower airways
and lead to bronchiectasis include:
- Blockage of your airways by a growth or a
noncancerous tumor
- Blockage of your airways by something you
inhaled—for example, a piece of a toy or a peanut that you inhaled when
you were a child
- Fungal infections
What Are the Signs and Symptoms of
Bronchiectasis?
The most common signs and symptoms are:
- Daily cough, over months or years
- Daily production of large amounts of mucus, or
phlegm (flem)
- Repeated lung infections
- Shortness of breath
- Wheezing
- Chest pain (pleurisy)
Over time, you may have more serious symptoms,
including:
Bronchiectasis can also lead to other serious health
conditions, including:
How Is Bronchiectasis Diagnosed?
There is no one specific test for bronchiectasis.
Even in its later stages, the signs of the disease are similar to those of
other conditions, so those conditions must be ruled out before a diagnosis can
be made.
Your doctor may suspect bronchiectasis if you have a
daily cough that produces large amounts of mucus.
Your doctor will determine if you have
bronchiectasis by conducting a series of tests to:
- Identify any underlying causes that need to be
treated
- Rule out other causes of your symptoms
- Determine the amount of damage to your lungs
The most commonly used tests to diagnose
bronchiectasis are:
- Chest x
ray. A chest x ray takes a picture of your heart and lungs. It can show
infection and scarring of your airway walls.
- Computed
tomography (CT) scan. This test provides a computer generated image of your
airways and other tissue in your lungs. It has more detail than a regular chest
x ray. A CT scan is the defining test for bronchiectasis. It can show how much
damage has been done to the airways and where the damage is.
Other tests your doctor may conduct include:
- Blood tests. These tests can show if you have a
disease or condition that can lead to bronchiectasis. They can also show if you
have an infection or low levels of certain infection-fighting blood cells.
- Sputum culture. Sputum contains mucus and often
pus, blood, or bacteria. Laboratory tests of a sample of your sputum can show
if you have bacteria, fungi, or tuberculosis.
- Lung function
tests. These tests measure how well your lungs move air in and out. These
tests show how much lung damage you have.
- Sweat test or other tests for cystic fibrosis.
This is a patch test on your arm that measures the amount of salt (sodium
chloride) in your sweat.
If your condition does not respond to treatment,
your doctor may request a
fiberoptic
bronchoscopy. In this procedure, your doctor inserts a long narrow,
flexible tube with a light on the end through your nose or mouth into your
airways. This tube is called a bronchoscope. It provides a video image of the
airways and allows your doctor to collect samples of mucus. This test can show
if something is blocking your lungs. You most likely would have this procedure
as an outpatient in a hospital, under local anesthesia.
How Is Bronchiectasis Treated?
The goals of treatment are to:
- Treat any underlying conditions and respiratory
infections
- Help remove mucus from your lungs
- Prevent complications
Early diagnosis and treatment of bronchiectasis are
important. The sooner your doctor can start treating any underlying conditions
that may be causing the bronchiectasis, the better the chances of preventing
further damage to your lungs.
The mainstays of treatment for bronchiectasis
are:
- Medications, especially antibiotics
- Chest physical therapy (CPT)
Medications
The main medicines used to treat bronchiectasis
are:
- Antibiotics are the main
treatment for the repeated respiratory infections that bronchiectasis causes.
Doctors usually prescribe oral antibiotics to treat these infections. For
hard-to-treat infections, you may be given antibiotics through a tube into a
vein in your arm. Your doctor may be able to help you arrange for a home care
provider to give you intravenous antibiotics at home.
- Bronchodilators open your
airways by relaxing the muscles around them. Inhaled bronchodilators can be
breathed in as a fine mist from a metered-dose inhaler (puffer) or a nebulizer
(ne'-byu-lye"-zer). These medicines work quickly because the drug goes directly
into your lungs. Doctors usually recommend that you use a bronchodilator right
before you do your chest physical therapy.
- Corticosteroids help reduce
inflammation in your lungs. They work best when you take them with an
inhaler.
- Mucus thinners, such as
acetylcysteine, loosen the mucus.
- Expectorants help loosen the
mucus in your lungs. They often come in combination with decongestants, which
may provide additional relief. You do not need a prescription for them.
- Saline nasal washes help control
sinusitis.
Chest Physical Therapy
CPT is also called chest clapping or percussion. It
involves pounding your chest and back over and over with your hands or a device
to loosen the mucus from your lungs so that you can cough it up. You should do
CPT for bronchiectasis three or four times each day.
CPT is often called postural drainage. This means
that you sit or lie on your stomach with your head down while you do CPT. This
lets gravity and force help drain the mucus from your lungs.
Some people find CPT difficult or uncomfortable to
do. Several devices have been developed that may help with CPT. The devices
include:
- An electric chest clapper, known as a mechanical
percussor.
- A removable inflatable therapy vest that uses
high-frequency air waves to force the mucus that is deep in your lungs toward
the upper airways so you can cough it up.
- A "flutter" device, a small handheld device that
you breathe out through. It causes vibrations that dislodge the mucus.
- A positive expiratory pressure mask that creates
vibrations that help break the mucus loose from the airway walls.
Several breathing techniques may also help loosen
some of the mucus so you can cough it up. These techniques include:
- Forced expiration technique (FET)forcing
out a couple of breaths or huffs and then doing relaxed breathing
- Active cycle breathing (ACB)FET with deep
breathing exercises that can loosen the mucus in your lungs
Depending on how serious your condition is, your
doctor may also recommend:
- Oxygen therapy.
- Surgery to remove a section of your lung. Doctors
usually do this only if other treatments have not helped and only one part of
your lung is affected. If you have major bleeding, your doctor may recommend
either surgery to remove the bleeding part of your lung or a procedure to
control the bleeding.
Living With Bronchiectasis
If you have bronchiectasis, you should work closely
with your doctor to develop self-management skills that can improve your
quality of life. This means that you need to learn as much as you can about
bronchiectasis and any underlying conditions that you have.
Avoiding respiratory infections should be a top
priority. To do this:
- Have annual flu vaccinations
- Have pneumonia vaccinations as directed by your
doctor
- Get regular aerobic exercise (walking and
swimming, for example) to help loosen the mucus so it can be coughed up
- Eat a healthy diet
- Drink lots of fluids
- Wash your hands often
- Maintain a healthy weight.
Other things you can do to improve your condition
include:
- Do not smoke
- Avoid exposure to tobacco smoke
- Avoid fumes and dust that can irritate your
lungs
Links to Other Information About Bronchiectasis
NHLBI Resources
Non-NHLBI Resources
Clinical Trials
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