What is bronchiectasis?

Bronchiectasis is a lung disease that can affect parts of the respiratory system. It involves a persistent cough and an inability to remove phlegm, or sputum. Part of the bronchial tree widens irreversibly, and it becomes flabby and scarred.

It has been defined as “persistent irreversible dilatation and distortion of medium-sized bronchi.”

In the past, changes related to bronchiectasis tended to develop during childhood, but improved hygiene standards, antibiotics, and immunization programs have made childhood infections less common, and bronchiectasis now affects people who are middle-aged and older.

In industrialized countries, bronchiectasis normally stems from an underlying medical condition that damages the airway walls or prevents them from removing mucus, such as cystic fibrosis or primary ciliary dyskinesia.

Over an 8-year period, Medicare data reported 1,106 cases of bronchiectasis per 100,000 people in the United States.

Bronchiectasis is serious. There is no cure, and complications can be fatal if it is left untreated. However, early diagnosis and treatment can prevent it from worsening.

Signs and symptoms of bronchiectasis

bronchiectasis
Bronchiectasis can cause a person to feel that they are short of breath.

Bronchiectasis is normally an acquired condition. It happens because of damage to the airways. The signs and symptoms may not appear for months, and sometimes not for years.

The most common signs and symptoms include a cough that continues daily for months or years. The cough may worsen when lying on one side.

Excessive sputum will be coughed up and spat out. The sputum may be foul-smelling and it may contain mucus, trapped particles, and pus.

The person is likely to experience wheezing and shortness of breath, and the lungs will crackle when heard through a stethoscope.

The flesh under the fingernails and toenails may become thicker, and nails may curve downward.

Later signs and symptoms may include:

Paleness or a bluish skin color

Weight loss

Slow growth in children

Fatigue

Coughing up of blood or bloody mucus

Breath odor.

Patients with severe bronchiectasis may eventually develop more serious conditions, such as a collapsed lung, respiratory failure, and eventually heart failure.

[diagram of lungs]
In bronchiectasis, the cilla in he bronchial tubes do not sweep mucus upwards.

In bronchiectasis the airways are damaged, and they widen instead of narrow. This is called bronchiectasia.

The linings of the bronchial tubes are covered in cilia and mucus. Mucus protects against undesirable particles that get into the lungs. Cilia are hair-like structures which sweep the particles and excess mucus upwards, out of the lung.

Usually a person does not notice the mucus coming out, unless an excess volume of mucus is pushed up, in which case the person will cough.

In bronchiectasis, the cilia in the bronchial tubes are destroyed or immobilized, so the particles and mucus are not swept upwards. Instead, they accumulate, as do bacteria. The sputum, or phlegm, can become sticky and difficult to move, even with coughing.

The accumulated sputum is an ideal environment for bacteria to multiply and cause infection, further damaging the bronchial tubes. As more sputum builds up, there is more bacteria, more infection, more damage and further sputum build up.

Conditions that increase the risk of bronchiectasis

The exact cause of bronchiectasis is unclear, but damage to the bronchial tubes may stem from tuberculosis (TB), pneumonia, a fungal infection, or whooping cough early in life. Measles can also damage the lungs.

[man coughing]
A persistent cough is a sign of bronchiectasis.

Other conditions that increase the risk include:

Cystic fibrosis, a chronic disease in which damage to the body’s organs causes mucus to become thick and sticky. This mucus can clog the airways, leading to infections and lung damage.

Young’s syndrome, in which a person’s mucus is abnormally viscous, in addition to other issues.

Allergic bronchopulmonary aspergillosis (ABPA) is an allergy to aspergillus, a type of fungus. This can lead to inflammation of the airways and the air sacs of the lungs. Untreated, it can result in bronchiectasis.

Primary ciliary dyskinesia (PCD), or Kartagener Syndrome (KS), is an inherited condition in which the cilia in the respiratory tract function poorly and cannot effectively sweep out secretions. This can lead to recurrent infections.

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