Bronchiectasis: Causes, symptoms, and treatment

Bronchiectasis is a lung condition that causes a persistent cough and excess phlegm, or sputum. It is a permanent condition that gets worse over time. It can be fatal.

The bronchi dilate, usually irreversibly, and phlegm builds up. This leads to recurrent lung infections and lung damage.

It can affect people with tuberculosis and cystic fibrosis, but these are not the only causes. Various processes and mechanisms can trigger this disorder.

There is no cure, but treatment can reduce infections and mucus build up. Symptoms vary in severity.

Older age increases the risk of, but bronchiectasis can affect all ages. In the United States (U.S.), it affects about 25 people in every 100,000. Over the age of 74 years, this increases to about 272 cases per 100,000 people.

The prevalence appears to be increasing.

Symptoms

[cough can be a sign of bronchiectasis]
A persistent cough can be a sign of bronchiectasis.

Symptoms are thought to start when sputum builds up in the respiratory system, leading to a cycle of problems.

More sputum means more bacteria in the airways, and this leads to inflammation and airway destruction. Then the cycle begins again with more mucus.

There are three main types of bronchiectasis, classified according to the resulting shape of the bronchi, visible on a CT scan of the lungs.

They are:

Cylindrical: The most common form, with even, cylinder-shaped bronchi

Varicose: The least common form. Bronchi are irregular, and the airways may be wide or constricted, leading to a higher production of sputum.

Cystic: Almost as common as cylindrical, but the bronchi form clusters of cysts. This is the most severe form.

The different types have similar symptoms are similar across the different types, but they differ in terms of severity.

They all feature enlargement of the breathing tubes of the lungs, or bronchi.

Other symptoms include:

a daily cough that continues for months or years

daily production of sputum in large amounts

shortness of breath and wheezing when breathing

chest pain

coughing up blood

A person with bronchiectasis who then gets an infection can experience a flare-up, and this can worsen the lung function.

[in bronchiectasis excess mucus leads to a cycle of damage]
Excess mucus encourages bacteria to thrive, leading to damage in the airways.

A wide range of factors can lead to it, including some congenital and autoinflammatory conditions and infections.

Infections that have been linked to bronchiectasis include:

tuberculosis (TB)

non-tuberculous mycobacteria

pneumonia

childhood infections, such as measles and whooping cough

Immunodeficiency conditions include:

hypogammaglobulinemia

leukemia

HIV and AIDS

chemotherapy

other treatments that suppress the immune system

It has also been linked to:

allergic bronchopulmonary aspergillosis

obstruction by a tumor or a foreign body

gastro-esophageal reflux

inhaling toxic fumes

auto-inflammatory conditions, such as rheumatoid arthritis, lupus, and ulcerative colitis, or Crohn’s disease

cystic fibrosis and some other congenital conditions

Between one third and one half of patients appear to have no identifiable cause.

Cystic fibrosis (CF) is a common cause of bronchiectasis in children. This is called CF bronchiectasis. Non-CF bronchiectasis is when the person has bronchiectasis but not CF.

Between 7 and 25 percent of patients with asthma or chronic obstructive pulmonary disease (COPD) also have bronchiectasis, but how these related to bronchiectasis remains unclear.

How does bronchiectasis affect the lungs?

Air passages in the respiratory system make it possible for oxygen to enter the lungs and for carbon dioxide to leave the body.

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