Bronchiectasis FAQs

Around one in 200 people in the UK has bronchiectasis, a long-term condition that irreversibly damages the airways of the lungs. 

Here, I’ll answer some of the most common questions that I hear about bronchiectasis as a Consultant Pulmonologist, from risk factors to treatment.

What is bronchiectasis?

Bronchiectasis is a chronic (long-term) condition affecting the lungs, specifically causing the airways (bronchi) to become inflamed and scarred. This ultimately leads to the bronchi widening and becoming less elastic. Damage caused by bronchiectasis is permanent. 

What causes bronchiectasis?

In around half of all cases of bronchiectasis in adults, the cause is unknown. When the cause can be identified, it is usually an infection, damage to the lungs or an underlying health condition. 

For example, you may develop bronchiectasis after contracting tuberculosis (TB), after a chest infection that leads to pneumonia or after infection with a fungus, such as Aspergillus fumigatus, which can cause allergic bronchopulmonary aspergillosis (ABPA).

Obstructions in your lungs also increase your risk of bronchiectasis. This may be caused by aspiration of a foreign object (eg food) into your lungs, or lung cancer where a tumour obstructs your airways.   

Who is most at risk of bronchiectasis? 

Your risk of bronchiectasis is higher if you have a chronic lung disease. This includes congenital diseases (ie a disease you are born with), such as cystic fibrosis (CF), alpha-1 antitrypsin (AAT) deficiency and primary ciliary dyskinesia (PCD), as well as acquired diseases, such as chronic obstructive pulmonary disease (COPD).

Your risk of bronchiectasis is also higher if your immune system is weakened or if you have an autoimmune condition. Consequently, bronchiectasis is more common in those with HIV, inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and connective tissue diseases, such as rheumatoid arthritis and Sjögren's syndrome.

Bronchiectasis also becomes more common with age, with around six in 10 cases of bronchiectasis occurring in those aged 70 and over. 

What are the symptoms of bronchiectasis?

The most common symptom of bronchiectasis is recurrent chest infections, usually three or more a year. 

You may also notice that you often feel tired, experience joint pain and chest pain, and/or a tightness in your chest. 

You may frequently wheeze and cough every day. This cough will produce mucus or phlegm (a productive cough) that you may struggle to cough up. You may also cough up blood. 

Around two or three in every 100 people with bronchiectasis will develop clubbing of their fingertips, that is, thickening of the tissue under the nail that causes the fingertip to become rounded. 

How is bronchiectasis diagnosed?

The first stage in diagnosing bronchiectasis involves your GP asking about your symptoms and medical history, and listening to your breathing with a stethoscope.

They may then recommend that you have a chest X-ray and may also collect a sample of your phlegm to be analysed in a lab for certain infections.

Depending on your results, they may then refer you to a doctor who specialises in treating lung conditions (a pulmonologist), who may recommend that you have a high-resolution CT scan (HRCT) of your chest. 

You may then need further tests to help identify the potential cause of your bronchiectasis. 

This may involve a lung function test using a handheld device called a spirometer; a gene test or a sweat test to check whether salt levels in your sweat are raised, which can be a sign of cystic fibrosis; a phlegm test to check for specific bacteria and fungi (if this hasn’t already been performed); and a blood test to check the health of your immune system as well as to check for infections. 

How is bronchiectasis treated?

Treating bronchiectasis involves breaking the cycle of infection that leads to inflammation, which puts you at greater risk of another infection, and so on. 

If you have a bacterial infection, you will, therefore, be prescribed a course of antibiotics. You may initially be prescribed a broad-spectrum antibiotic while waiting for the results of a phlegm test, which can identify the specific bacteria causing your infection. Depending on your phlegm test results, you may receive a more targeted antibiotic or a combination of antibiotics.

If you have three or more chest infections in a year or your symptoms during a chest infection are very severe, your doctor may prescribe long-term antibiotics. However, you will still need to have regular phlegm tests to check for the type of bacteria that causes these infections. 

Your doctor may also prescribe drugs to help thin the mucus in your airways so you can more easily clear it — in some cases, you may be provided with a nebuliser so you can inhale the drug. 

Additionally, chest physiotherapy will be recommended to help you clear the mucus from your airways. You will need to perform these exercises daily to help reduce mucus accumulation in your airways. 

If you experience a flare-up of your symptoms, your doctor may prescribe a bronchodilator so that you can inhale medication to help you breathe more easily in the short term. 

What are the potential complications of bronchiectasis? 

Bronchiectasis can increase your risk of massive haemoptysis, that is, coughing up large amounts of blood. This occurs when one of the blood vessels supplying your lungs suddenly splits open. This is a medical emergency and needs emergency treatment. 

Bronchiectasis also increases your risk of recurrent chest infections, which can lead to permanent lung damage that reduces how well your lungs work (lung function). This, consequently, increases the likelihood that you will need to be treated in hospital when you develop a chest infection.

Additionally, bronchiectasis can increase your risk of cardiovascular problems, such as coronary heart disease and stroke.  

Does bronchiectasis reduce life expectancy?

Yes, bronchiectasis can reduce your life expectancy. However, if the condition is caught early and managed appropriately, both medically and with lifestyle changes, you can have a normal life expectancy. 

What lifestyle changes can help manage bronchiectasis?

If you have bronchiectasis, it’s important to take any medications prescribed by your doctor as instructed and perform your daily physiotherapy exercises. 

Following a healthy balanced diet, reducing how much caffeine you drink and exercising regularly will also help keep your body as fit as possible so you can better manage your bronchiectasis. 

To reduce your risk of flare-ups and chest infections, you should also make sure you stay up to date with all of your vaccinations, including your annual flu vaccination and either a one-off or five-yearly pneumococcal vaccination. 

If you notice that you’ve developed an infection, it is important to access the help you need as soon as possible (eg see your GP) and rest when needed to help your body fight off the infection. 

Quitting smoking is also vital to help maintain the health of your lungs.