Bronchiectasis

Overview

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Bronchiectasis is a chronic and progressive lung condition characterized by the abnormal and permanent widening of the bronchi—the airways in the lungs. This dilation results from inflammation or infection that causes damage to the bronchial walls. The affected airways lose their ability to effectively clear mucus, leading to a cycle of recurrent infections, inflammation, and further lung damage. While bronchiectasis can affect people of any age, it is more commonly diagnosed in older adults. It may occur as a result of underlying conditions such as cystic fibrosis, immunodeficiency disorders, or chronic infections, but in many cases, the exact cause remains unknown (referred to as idiopathic bronchiectasis).

Bronchiectasis is considered a serious respiratory disease that impacts the quality of life and, if left untreated, can lead to severe complications. However, with proper management, many individuals can lead active and relatively healthy lives.

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Symptoms

The symptoms of bronchiectasis can vary depending on the severity and extent of the disease but generally include:

  • Chronic cough: A persistent cough that produces large amounts of mucus (sputum) is the hallmark symptom.
  • Frequent lung infections: Repeated episodes of bronchitis or pneumonia are common.
  • Shortness of breath: Especially during physical activity.
  • Fatigue: Due to chronic infection and reduced oxygen exchange.
  • Wheezing: A whistling sound while breathing.
  • Chest pain: Often due to inflammation and infection.
  • Hemoptysis: Coughing up blood or blood-stained sputum, particularly during flare-ups.
  • Clubbing of fingers: Thickening and widening of the fingertips in long-term cases.
  • Symptoms may be persistent or episodic, with worsening during periods of exacerbation.
Complications

If not properly managed, bronchiectasis can lead to several complications, including:

  • Respiratory failure: As lung function declines over time.
  • Massive hemoptysis: Severe bleeding in the lungs can be life-threatening.
  • Atelectasis: Collapse of part or all of a lung due to blockage of airways.
  • Lung abscess: Formation of pus-filled cavities in the lungs.
  • Cor pulmonale: A condition where the right side of the heart enlarges due to increased pressure in the lungs.
  • Reduced quality of life: Chronic fatigue, breathlessness, and infections can severely affect day-to-day functioning.
Causes

Bronchiectasis may be caused by a range of conditions or events that damage the airways. These include:

  • Cystic Fibrosis: A genetic disorder that is the most common cause of bronchiectasis in children.
  • Severe or repeated lung infections: Such as pneumonia, tuberculosis, or whooping cough.
  • Immune system disorders: That reduce the body’s ability to fight infection.
  • Allergic bronchopulmonary aspergillosis (ABPA): A reaction to a common fungus.
  • Obstruction: From inhaled foreign objects or tumors.
  • Autoimmune diseases: Such as rheumatoid arthritis or Sjögren’s syndrome.
  • Primary ciliary dyskinesia: A rare condition where cilia (tiny hairs in the lungs) don't work properly.
  • Idiopathic causes: In many cases, no definitive cause is identified.
Prevention

Although not all cases of bronchiectasis can be prevented, the following measures can help reduce the risk:

  • Prompt treatment of respiratory infections: To prevent damage to the lungs.
  • Vaccination: Against measles, whooping cough, influenza, and pneumococcus to prevent respiratory illnesses.
  • Avoidance of lung irritants: Such as tobacco smoke, air pollution, and occupational fumes.
  • Managing chronic conditions: Such as asthma or gastroesophageal reflux disease (GERD).
  • Physiotherapy and airway clearance techniques: For people at risk or with underlying diseases.
  • Early diagnosis and treatment: Of conditions like cystic fibrosis or immunodeficiencies.
Risk Factors

Several factors increase the risk of developing bronchiectasis, including:

  • Cystic fibrosis: The leading cause in many parts of the world.
  • Recurrent lung infections: Especially during childhood.
  • Impaired immune system: Due to HIV, chemotherapy, or congenital conditions.
  • Chronic inflammatory conditions: Like rheumatoid arthritis.
  • Gastroesophageal reflux: Aspiration of stomach acid can damage airways.
  • Congenital lung abnormalities
  • Age: More common in older adults.
  • Smoking history: Though not a direct cause, it contributes to lung damage.
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How is it Diagnosed?

Bronchiectasis is a chronic condition characterized by permanent dilation and damage of the bronchi, leading to recurrent lung infections and impaired mucus clearance. The diagnostic process begins with a detailed clinical history, focusing on persistent cough, daily sputum production, recurrent respiratory infections, and shortness of breath. Physical examination may reveal crackles, wheezing, or digital clubbing.

A high-resolution computed tomography (HRCT) scan of the chest is the gold standard for diagnosis, clearly showing bronchial dilatation, thickening, and lack of normal tapering. A plain chest X-ray may suggest the diagnosis but is less sensitive.

Pulmonary function tests (PFTs) help assess the degree of airway obstruction or restriction. Sputum culture and sensitivity testing are important for identifying chronic bacterial colonization, especially with organisms like Pseudomonas aeruginosa. Blood tests, including immunoglobulin levels and tests for autoimmune conditions or allergic bronchopulmonary aspergillosis (ABPA), are also conducted to determine underlying causes.

In children or young adults, screening for cystic fibrosis may be indicated using a sweat chloride test or genetic analysis. Flexible bronchoscopy may be used to rule out foreign bodies or airway tumors and to obtain samples for microbiological assessment. Comprehensive evaluation by a pulmonologist is often essential, and diagnosis is typically confirmed based on imaging and clinical correlation.

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FAQs

No. While bronchiectasis shares symptoms like chronic cough and shortness of breath with COPD and asthma, it is a distinct condition involving permanent airway dilation. However, some people may have overlapping conditions.

There is no cure for bronchiectasis, but with effective treatment and lifestyle modifications, the condition can be well-managed and progression can be slowed.

No. Bronchiectasis itself is not contagious. However, the infections that cause or exacerbate it may be.

Diagnosis is typically made through a high-resolution CT (HRCT) scan, which provides detailed images of the airways. Pulmonary function tests, sputum analysis, and bronchoscopy may also be used.

With proper management, many patients live a normal or near-normal life span. The prognosis depends on the severity, underlying cause, and how well the disease is controlled.

Yes. Regular physical activity can improve lung function, reduce mucus build-up, and enhance overall health. Pulmonary rehabilitation is also beneficial.

A balanced diet supports immune function and overall health. In advanced cases, nutritional support may be needed due to increased caloric demands.

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