Overview
Bronchiectasis is a long-term lung condition in which some of the airways (bronchial tubes) become damaged, wider than normal and scarred. Damaged airways cannot clear mucus well. Phlegm builds up and traps germs, which leads to repeated chest infections, and each infection can damage the airways further.
It can affect one part of a lung or many parts of both lungs. It cannot be cured, but with the right care most people can have a good quality of life.
Symptoms
- A cough that lasts for weeks or months, usually bringing up a lot of phlegm (clear, white, yellow or green)
- Chest infections that keep coming back
- Shortness of breath and wheezing
- Tiredness
- Chest pain
- Coughing up blood
Symptoms often develop slowly, sometimes months or years after the illness that damaged the airways. Flare-ups, when symptoms get worse for days or weeks, are common.
When to see a doctor
See a doctor soon if your cough or phlegm suddenly gets much worse or changes in colour or amount, if you cough up small amounts of blood, if you are more breathless than usual, or if you have a high temperature or chest pain on breathing or coughing. See a doctor too for a cough lasting more than three weeks.
Causes
Bronchiectasis is caused by damage to the airway walls, usually after repeated infection and inflammation. Causes include:
- A severe lung infection in the past, such as pneumonia, tuberculosis, measles, whooping cough or COVID-19
- Other lung conditions, such as asthma, COPD or cystic fibrosis
- Immune system problems
- Rheumatoid arthritis and inflammatory bowel disease
- Breathing in a foreign object, food particles or other harmful substances
In many people, no cause is found.
Risk factors
- A severe chest infection in childhood or later in life
- Asthma, COPD or cystic fibrosis
- A weak immune system
- Rheumatoid arthritis or inflammatory bowel disease
- Breathing in substances that damage the lungs
Complications
How much it affects daily life depends on how severe it is and how often infections occur. Possible complications include:
- Frequent chest infections and repeated pneumonia
- Coughing up blood
- Low oxygen levels and, in severe disease, breathing failure
- Strain on the heart, and heart failure
- A collapsed lung (pneumothorax)
- Low mood or depression
Prevention
The damage cannot be undone, but these steps lower the chance of infections that make it worse:
- A yearly flu , and the pneumococcal and COVID-19 vaccines as advised
- Keeping childhood vaccinations up to date
- Not smoking
- Washing hands often and keeping away from people with colds or flu
- Treating lung infections promptly
Diagnosis
The doctor listens to the chest, where crackling or wheezing may be heard, and asks about the cough and past infections. Tests may include:
- A phlegm sample, tested for germs
- A chest X-ray
- Breathing tests ()
- Blood tests, including tests for immune problems
- A of the chest, which confirms bronchiectasis
- Further tests to look for a cause, such as cystic fibrosis
Treatment
There is no cure, but treatment keeps the condition under control. Care is often shared between a doctor, a nurse, a chest physiotherapist and sometimes a lung specialist, with regular check-ups. Any underlying cause is treated too.
Clearing the airways every day is the foundation. A physiotherapist teaches breathing and coughing techniques that bring up phlegm, sometimes with a hand-held device or a salt-water mist () to loosen it. Exercise and pulmonary rehabilitation also help.
are given for flare-ups. Some people with frequent infections take them over a long period, or keep a supply at home to start early. Inhalers may ease breathlessness. In severe cases, oxygen at home, surgery to remove a badly damaged part of the lung, or a lung transplant may be considered.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“A cough with a lot of phlegm that keeps coming back is just a weak chest, and nothing can be done.”What is true?
Fact
A cough that lasts weeks or months, with a lot of phlegm and repeated chest infections, should be checked, because it can be bronchiectasis. A CT scan can confirm it, and starting treatment early helps to prevent further lung damage.
Myth“It is always caused by TB, so TB medicines will fix it.”What is true?
Fact
A past lung infection such as TB is one possible cause. Others include pneumonia, measles, whooping cough, asthma, COPD, immune problems and conditions such as rheumatoid arthritis, and in many people no cause is found. The treatment depends on the cause.
Myth“Once the antibiotics are finished, the bronchiectasis is cured.”What is true?
Fact
Antibiotics treat chest infections, but the widening of the airways is permanent and cannot be cured. Treatment keeps it under control, and most people can have a good quality of life.
Myth“With a lung condition, it is best to rest and avoid exercise.”What is true?
Fact
Regular exercise, within what your care team advises, is part of looking after bronchiectasis. A pulmonary rehabilitation programme of exercise and education may be offered to ease breathlessness.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Can bronchiectasis be cured?
The damage to the airways is permanent, so it cannot be cured. Treatment can control symptoms, reduce flare-ups and help prevent more damage. Most people can have a good quality of life.
How is it different from COPD or asthma?
It is a separate condition, although it often occurs alongside asthma or COPD. In bronchiectasis the airways are permanently widened and prone to mucus build-up, and a CT scan can show this.
Do I need to do the airway-clearing exercises every day?
They are usually done every day as part of the long-term plan. Clearing phlegm regularly helps stop germs building up. A physiotherapist can teach the method that suits you.
What should I do during a flare-up?
A flare-up means your cough, phlegm or breathlessness gets worse for days. Contact your doctor promptly, as a phlegm sample may be tested and antibiotics started. Get emergency care if you cough up more than a few streaks of blood or have severe difficulty breathing.