What Is Bronchiectasis?

Bronchiectasis (brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs.

Bronchiectasis usually is the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles.

In bronchiectasis, your airways slowly lose their ability to clear out mucus. When mucus can't be cleared, it 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, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.

Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis), and heart failure.

Bronchiectasis

Figure A shows a cross-section of the lungs with normal airways and with widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.

Overview

Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs.

The initial lung damage that leads to bronchiectasis often begins in childhood. However, symptoms may not appear until months or even years after you start having repeated lung infections.

In the United States, common childhood infections, such as whooping cough and measles, used to cause many cases of bronchiectasis. However, these causes are now less common due to the use of vaccines and antibiotics.

Now, in the United States, bronchiectasis usually is due to an underlying medical condition that injures the airway walls or prevents the airways from clearing mucus. Examples of such conditions include cystic fibrosis and primary ciliary dyskinesia (SIL-e-ar-e dis-ki-NE-ze-ah).

Bronchiectasis that occurs in only one part of the lung may be due to a blockage rather than an underlying condition.

Bronchiectasis can be congenital or acquired. Congenital bronchiectasis usually affects infants and children. It's the result of a problem with how the lungs form in a fetus.

Acquired bronchiectasis occurs as a result of another medical condition. It can affect adults and older children. This type of bronchiectasis is more common than the congenital type.

Outlook

Bronchiectasis can't be cured. However, with proper care, most people who have it can enjoy a good quality of life.

Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating your bronchiectasis and any underlying conditions, the better the chances of preventing further damage to your lungs.

Other Names for Bronchiectasis

• Acquired bronchiectasis
• Congenital bronchiectasis

What Causes Bronchiectasis?

An injury to the walls of your airways usually causes bronchiectasis. A lung infection may cause this injury. For example, severe pneumonia (nu-MO-ne-ah), whooping cough or measles (now uncommon due to vaccination), tuberculosis, or fungal infections can injure the airways and lead to bronchiectasis.

Often, people who have bronchiectasis have an underlying condition that damages their airways and increases their risk for lung infections. Examples of such conditions include:

• Cystic fibrosis. This disease leads to almost half of the cases of bronchiectasis in the United States.
• Immunodeficiency disorders, such as common variable immunodeficiency and, less often, HIV and AIDS.
• Allergic bronchopulmonary aspergillosis (AS-per-ji-LO-sis). This is an allergic reaction to a fungus called aspergillus. The reaction causes swelling in the airways.
• Disorders that affect cilia (SIL-e-ah) function, such as primary ciliary dyskinesia. Cilia are small, hair-like structures that line your airways. They normally clear mucus (a slimy substance) out of your airways.

Other conditions, such as a blockage in your airways, also can lead to bronchiectasis. A blockage may be due to a growth, a noncancerous tumor, or something inhaled, such as a piece of a toy or a peanut that you inhaled as a child.

Congenital bronchiectasis is the result of a problem with how the lungs form in a fetus. This condition usually affects infants and children.

Who Is At Risk for Bronchiectasis?

People who have an underlying condition that causes lung damage or increases their risk for lung infections have a higher risk for bronchiectasis. Such conditions include:

• Cystic fibrosis. This disease leads to almost half of the cases of bronchiectasis in the United States.
• Immunodeficiency disorders, such as common variable immunodeficiency and, less often, HIV and AIDS.
• Allergic bronchopulmonary aspergillosis. This is an allergic reaction to a fungus called aspergillus. The reaction causes swelling in the airways.
• Disorders that affect cilia function, such as primary ciliary dyskinesia. Cilia are small, hair-like structures that line your airways. They normally clear mucus (a slimy substance) out of your airways.

An estimated 110,000 people are living with bronchiectasis in the United States. Bronchiectasis can develop at any age. Overall, two-thirds of people who have the condition are women. However, in children, the condition is more common in boys than in girls.

What Are the Signs and Symptoms of Bronchiectasis?

The initial airway damage that leads to bronchiectasis often begins in childhood. However, signs and symptoms may not appear until months or even years after you start having repeated lung infections.

The most common signs and symptoms of bronchiectasis are:

• A daily cough, over months or years
• Daily production of large amounts of sputum (spit). Sputum, which you cough up and spit out, may contain mucus (a slimy substance), trapped particles, and pus.
• Shortness of breath and wheezing (a whistling sound when you breathe)
• Chest pain
• Clubbing (the flesh under your fingernails and toenails gets thicker)

If your doctor listens to your lungs with a stethoscope, he or she may hear abnormal lung sounds.

Over time, you may have more serious symptoms. You may cough up blood or bloody mucus and feel fatigued (very tired). Children may lose weight, or they may not grow at a normal rate.

Severe bronchiectasis also can lead to other serious health conditions, such as respiratory failure and atelectasis. If the condition is so advanced that it affects all parts of your airways, it may cause heart failure.

How Is Bronchiectasis Diagnosed?

Your doctor may suspect bronchiectasis if you have a daily cough that produces large amounts of sputum (spit).

To find out whether you have bronchiectasis, your doctor may recommend tests to:

• Identify any underlying causes that need to be treated
• Rule out other causes of your symptoms
• Find out how much your airways have been damaged

Diagnostic Tests and Procedures

Chest Computed Tomography Scan

The most commonly used test to diagnose bronchiectasis is a chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan.

This painless test creates precise images of your airways and other structures in your chest. It can show how much your airways are damaged and where the damage is. A chest CT scan gives more detailed pictures than a regular chest x ray.

Chest X Ray

You also may have a chest x ray. This painless test creates pictures of the structures in your chest, such as your heart and lungs. A chest x ray may show areas of abnormal lung and thickened, irregular airway walls.

Other Tests

You also may have other tests, such as:

• Blood tests. These tests can show whether you have an underlying condition that can lead to bronchiectasis. They also can show whether you have an infection or low levels of certain infection-fighting blood cells.
• A sputum culture. Lab tests of a sample of your sputum can show whether you have bacteria (such as the bacteria that cause tuberculosis) and fungi.
• Lung function tests. These tests measure the size of your lungs, how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. Lung function tests help show how much lung damage you have.
• A sweat test or other tests for cystic fibrosis.

Bronchoscopy

If your bronchiectasis doesn't respond to treatment, your doctor may recommend a bronchoscopy (bron-KOS-ko-pee). This procedure is used to look at the insides of the airways.

During this procedure, a long, narrow, flexible tube with a light on the end is inserted through your nose or mouth into your airways. This tube is called a bronchoscope. It provides a video image of your airways. You'll be given medicines to numb the upper airway and to help you relax during the procedure.

Bronchoscopy can show whether something is blocking your airways. If there is bleeding, this procedure can show where the bleeding is coming from.

How Is Bronchiectasis Treated?

Bronchiectasis often is treated with medicines, hydration, and chest physical therapy (CPT).

If the bronchiectasis is isolated to a section of the lung, or if there's a lot of bleeding, surgery may be recommended. If the bronchiectasis is widespread and causing respiratory failure, your doctor may recommend oxygen.

The goals of treatment are to:

• Treat any underlying conditions and lung infections.
• Help remove mucus (a slimy substance) from your lungs. Maintaining good hydration helps with the removal of mucus.
• Prevent complications.

Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating your bronchiectasis and the underlying condition, the better the chances of preventing further damage to your lungs.

Medicines

To treat bronchiectasis, your doctor may prescribe antibiotics, bronchodilators, expectorants, or mucus-thinning medicines.

Antibiotics are the main treatment for the repeated lung infections that bronchiectasis causes. Oral antibiotics often are used to treat these infections.

For hard-to-treat infections, you may be given antibiotics through an intravenous (IV) line inserted into your arm. Your doctor may be able to help you arrange for a home care provider to give you IV antibiotics at home.

Bronchodilators open your airways by relaxing the muscles around them. Inhaled bronchodilators can be breathed in as a fine mist using an inhaler or a nebulizer.

Inhaled bronchodilators work quickly because the medicine goes directly to your lungs. Your doctor may recommend that you use a bronchodilator right before you do CPT.

Your doctor also may recommend medicines such as expectorants and mucus thinners to help you cough up mucus.

Expectorants help loosen the mucus in your lungs. They often are combined with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.

For some of these treatments, little information is available to determine how well they work.

Hydration

Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery, which makes it easier to cough up.

Chest Physical Therapy

CPT also is called physiotherapy (FIZ-e-o-THER-a-pe) or 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 may sit with your head tilted down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.

Some people find CPT hard or uncomfortable to do. Several devices have been developed that may help with CPT, such as:

• An electric chest clapper, known as a mechanical percussor.
• An inflatable therapy vest that uses high-frequency air waves to force the mucus that's deep in your lungs toward your upper airways so you can cough it up.
• A small handheld device that you breathe out through. It causes vibrations that dislodge the mucus.
• A mask that creates vibrations that help break the mucus loose from your airway walls.

Some of the methods and devices are popular with patients and doctors, but little information is available on how well they actually work. Choice usually is based on convenience and cost.

Several breathing techniques also are used that may help move mucus to the upper airways so you can cough it up. These techniques include forced expiration technique (FET) and active cycle breathing (ACB).

FET involves forcing out a couple of breaths and then doing relaxed breathing. ACB is FET that involves deep breathing exercises.

Other Treatments

Depending on your condition, your doctor also may recommend oxygen therapy or surgery to remove a section of your lung.

Oxygen therapy can help raise low blood oxygen levels. For this treatment, you're given oxygen through nasal prongs or a mask. Oxygen therapy may be done at home or in a hospital or other health facility.

Surgery may be used if no other treatments have helped and only one part of your airway is affected. If you have major bleeding, your doctor may recommend either surgery to remove the bleeding part of your airway or a procedure to control the bleeding.

How Can Bronchiectasis Be Prevented?

To prevent bronchiectasis, it's important to prevent the lung infections and lung damage that can cause it.

Childhood vaccines against measles and whooping cough prevent infection with these illnesses. These vaccines also reduce complications from these infections, such as bronchiectasis.

It may help to avoid toxic fumes, gases, smoke, and other substances that can harm your lungs.

Proper treatment of lung infections in children also may help preserve lung function and prevent lung damage that can lead to bronchiectasis.

Stay alert to keep children (and adults) from inhaling small objects (such as pieces of toys and food that might stick in a small airway). If you think you, your child, or someone else has inhaled a small object, seek prompt medical care.

Living With Bronchiectasis

Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating your bronchiectasis and any underlying conditions, the better the chances of preventing further damage to your lungs.

Ongoing Care

If you have bronchiectasis, work closely with your doctor to learn ways that you can improve your quality of life. This involves learning as much as you can about bronchiectasis and any underlying conditions that you have.

Taking steps to avoid lung infections is very important. Talk to your doctor about getting flu and pneumonia vaccines. Wash your hands often to lower your risk for viruses and bacterial infections.

Healthy Lifestyle

Follow a healthy diet and be as physically active as you can. A healthy diet includes a variety of fruits, vegetables, and whole grains.

It also includes lean meats, poultry, fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

It's also important to stay hydrated. Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky.

Also, try to be as physically active as you can. Activities, such as walking and swimming, can help loosen mucus so it can be coughed up. Talk to your doctor about what types and amounts of activity are safe for you.

Other steps you can take to protect your airways include not smoking and avoiding lung irritants, such as secondhand smoke, dust, and fumes. If you smoke, talk to your doctor about programs and products that can help you quit.

Key Points

• Bronchiectasis is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs.
• Bronchiectasis usually is the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles.
• In bronchiectasis, your airways slowly lose their ability to clear out mucus. When mucus can't be cleared, it 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, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.
• Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis, and heart failure.
• In the United States, common childhood infections, such as whooping cough and measles, used to cause many cases of bronchiectasis. However, these causes are now less common due to the use of vaccines and antibiotics.
• Now, in the United States, bronchiectasis usually is due to an underlying medical condition that injures the airway walls or prevents the airways from clearing mucus. Examples of such conditions include cystic fibrosis and primary ciliary dyskinesia.
• Congenital bronchiectasis is the result of a problem with how the lungs form in a fetus. This type of bronchiectasis usually affects infants and children.
• Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs.
• The initial damage that leads to bronchiectasis often begins in childhood. However, signs and symptoms may not appear until months or even years after you start having repeated lung infections.
• The most common signs and symptoms of bronchiectasis are a daily cough (over months or years), daily production of large amounts of sputum (spit), shortness of breath and wheezing, chest pain, and clubbing.
• Over time, you may have more serious symptoms. You may cough up blood or bloody sputum and feel fatigued (very tired). Children may lose weight, or they may not grow at a normal rate.
• Your doctor will diagnose bronchiectasis based on your signs and symptoms and the results from tests and procedures.
• Bronchiectasis is treated with medicines, hydration, chest physical therapy (CPT), oxygen, and surgery. Medicines, especially antibiotics, and CPT are the standard treatments for the condition.
• To prevent bronchiectasis, it's important to prevent lung infections and lung damage that can cause it. Childhood vaccines against measles and whooping cough prevent infections with these illnesses. It also may help to avoid toxic fumes, gases, smoke, and other substances that can harm your lungs.
• Proper treatment of lung infections in children also may help prevent lung damage that can lead to bronchiectasis.
• Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating your bronchiectasis and any underlying conditions, the better the chances of preventing further damage to your lungs.
• If you have bronchiectasis, work closely with your doctor to learn ways that you can improve your quality of life. This involves learning as much as you can about bronchiectasis and any underlying conditions that you have. Take steps to avoid lung infections, stay well hydrated, and follow a healthy lifestyle.
• Bronchiectasis can't be cured. However, with proper care, most people who have the condition can enjoy a good quality of life.

Links to Other Information About Bronchiectasis

NHLBI Resources

• Cystic Fibrosis (Diseases and Conditions Index)

Non-NHLBI Resources

• Bronchiectasis (MedlinePlus)

Clinical Trials

• Current Research (ClinicalTrials.gov)
• NHLBI Pediatric Clinical Trials