Bronchiectasis

When you breathe, air is carried into your lungs through your airways, also called bronchi. The bronchi divide repeatedly into thousands of smaller airways called bronchioles. Your airways contain tiny glands that produce a small amount of mucus. Mucus helps to keep your airways moist, and traps the dust and germs that you breathe in. The mucus is moved away by tiny hairs, called cilia, which line your airways.

If you have bronchiectasis, your airways are widened and inflamed with thick mucus, also called phlegm or sputum. Your airways may not clear themselves properly. This means mucus builds up and your airways can become infected by bacteria. Pockets in the airways mean that mucus gets trapped and is likely to get infected.

If you smoke, the cilia (hairs) lining your airways become damaged and are unable to clear the mucus within the airways. This acts to compound (worsen) the effects of bronchiectasis and promotes pooling of mucus in the lungs which in turn increases the risk of bacterial infection.

It is important to recognise and treat chest infections. Without treatment, the airways may be damaged further.

For up to half of people diagnosed with bronchiectasis, there is no clear underlying cause. This is called idiopathic bronchiectasis.

Some illnesses linked to bronchiectasis include:

• having had severe lung infections such as pneumonia, whooping cough or tuberculosis (TB) in the past, for example when you were a child
• inflammatory bowel disease, also called ulcerative colitis and Crohn’s disease
• immune system deficiencies
• some types of arthritis, such as rheumatoid arthritis
• asthma, COPD or sarcoidosis

Other causes include:

• a severe allergic response to fungus or moulds such as Aspergillus
• gastric reflux
• a blockage of your airways, caused by breathing in a small item such as a nut

The Symptoms of bronchiectasis vary between people. You may have 1 or 2 on the list below, or you may have most of them.

The most common symptom is a long-term cough, usually coughing up sputum, sometimes called phlegm. The amount varies. For people with more severe bronchiectasis, it can be quite large amount, for example an egg cup full or more every day. Some people might have a dry cough with no or very little sputum.

Frequent chest infections are also a common feature of bronchiectasis.

Other symptoms of bronchiectasis you might have are:

• feeling very tired or finding it difficult to concentrate
• breathlessness
• problems with your sinuses
• cough incontinence, also called stress incontinence
• anxiety or depression

Less common symptoms of bronchiectasis include:

• coughing up blood
• chest pain

If you have not previously been diagnosed with bronchiectasis and you develop a persistent cough, contact your GP for advice.

While persistent coughing may not necessarily be the result of bronchiectasis, it requires further investigation.

Contact your GP surgery as soon as possible if you cough up blood, even if it is just a few spots or specks. Call NHS 111 or your local out of hours service if you can’t speak to your GP

Your GP will check if you might have a serious medical condition that needs to be investigated and treated.

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you are coughing up a lot of blood or are struggling to breathe.

If you have been diagnosed with bronchiectasis previously and begin to experience symptoms that suggest you have a lung infection, contact a GP.

You will usually need treatment with antibiotics.

Some people with bronchiectasis are given a stock of antibiotics as a precaution in case they suddenly develop a lung infection.

The GP will ask you about your symptoms, such as how often you cough, whether you bring up any phlegm (sputum), and whether you smoke.

They may also listen to your lungs with a stethoscope as you breathe in and out. The lungs of people with bronchiectasis often make a distinctive crackling noise as a person breathes in and out.

Your GP will probably organise a chest X-ray to rule out other causes of your symptoms.

If the GP thinks you may have a lung infection, they may take a sample of your phlegm so it can be checked for bacteria.

If your GP suspects that you have bronchiectasis, you will be referred to a doctor who specialises in treating lung conditions (a respiratory consultant) for further testing.

Some of the tests a respiratory consultant may carry out to help diagnose bronchiectasis are described below.

HRCT scan

Currently, the most effective test available to diagnose bronchiectasis is called a high-resolution CT (HRCT) scan. A HRCT scan involves taking several X-rays of your chest at slightly different angles. A computer is then used to put all the images together. This produces a very detailed picture of the inside of your body, and the airways inside your lungs (the bronchi) should show up very clearly.

In a healthy pair of lungs, the bronchi should become narrower the further they spread into your lungs, in the same way a tree branch separates into narrower branches and twigs. If the scan shows that a section of airways is getting wider, this usually confirms bronchiectasis.

Other tests

Other tests can be used to assess the state of your lungs and to try to determine what the underlying cause of your bronchiectasis may be.

These tests may include:

• blood tests – to check how well your immune system is working and check for infectious agents, such as bacteria, viruses, and fungi
• phlegm (sputum) test – to check for bacteria or fungi
• a sample of your sweat can be tested to see how much salt is in it – high levels of salt can be caused by cystic fibrosis (if this test is positive, a more detailed genetic test can be carried out; see diagnosing cystic fibrosis for more information)
• lung function test – a small, handheld device (a spirometer) that you blow into is used to measure how hard and how quickly you can expel air from your lungs; this can assess how well your lungs are working
• bronchoscopy – a flexible tube with a camera at one end is used to look into your lungs; this test is only occasionally required for investigating bronchiectasis

The damage caused to the lungs by bronchiectasis is permanent, but treatment can help relieve your symptoms and stop the damage getting worse.

In most cases, treatment involves a combination of medication, exercises you can learn and devices to help clear your airways. Surgery for bronchiectasis is rare.

The main treatments include:

• exercises and special devices to help you clear mucus out of your lungs
• medicine to help improve airflow within the lungs
• antibiotics to treat any lung infections that develop

Read more about the treatment of bronchiectasis.

There are a number of things you can do to help relieve the symptoms of bronchiectasis and stop the condition getting worse, including:

• stopping smoking (if you smoke)
• having the flu vaccine every year
• making sure you have had the pneumococcal vaccine to protect against pneumonia
• exercising regularly
• keeping yourself well hydrated
• eating a balanced diet

• Bronchiectasis – British Lung Foundation website
• Bronchiectasis patient information leaflet – Oxford University Hospitals .pdf download
• Bronchiectasis Discussion Forum – Patient UK
• Living with Bronchiectasis: Joyce’s story – The European Lung Foundation YouTube video

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

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If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

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