Bronchiectasis: Symptoms, Causes & Treatment

What Is Bronchiectasis?

Bronchiectasis is a chronic lung condition where the bronchi (airways) become permanently widened and damaged, preventing normal mucus clearance. This leads to mucus buildup, chronic cough, and recurrent respiratory infections. The condition affects approximately 350-566 per 100,000 adults and is more common in women and older people.

When you breathe, air travels through your airways (bronchi) which branch into smaller and smaller tubes throughout your lungs. Inside these airways, tiny hair-like structures called cilia constantly move mucus upward, where it can be coughed out. This mucus traps bacteria, viruses, and particles you breathe in, keeping your lungs clean and healthy.

In bronchiectasis, parts of the airways become abnormally stretched and widened, often due to damage from previous infections or underlying conditions. When the airways are damaged, the cilia cannot function properly, and mucus accumulates instead of being cleared. This stagnant mucus becomes a breeding ground for bacteria, leading to a cycle of infection, inflammation, and further airway damage.

The word "bronchiectasis" comes from the Greek words "bronkhos" (windpipe) and "ektasis" (stretching or dilation). The condition was first described in the early 19th century, and before antibiotics became available, it was often fatal. Today, with proper management and treatment, most people with bronchiectasis can maintain a good quality of life, though the condition remains chronic and requires ongoing care.

Types of bronchiectasis

Bronchiectasis can be classified based on the appearance of the damaged airways on CT scans. Understanding these types helps doctors assess severity and plan treatment:

• Cylindrical bronchiectasis: The mildest form, where airways are uniformly dilated with smooth, parallel walls. This is the most common type and often responds well to treatment.
• Varicose bronchiectasis: Airways have irregular walls with alternating areas of dilation and constriction, resembling varicose veins. This represents moderate severity.
• Cystic (saccular) bronchiectasis: The most severe form, where airways end in large, balloon-like sacs filled with mucus or fluid. This type is often associated with more symptoms and complications.

The extent of bronchiectasis also matters – it may be localized (affecting one area of the lung) or diffuse (affecting multiple areas). Localized bronchiectasis often has a specific cause that can sometimes be treated, while diffuse bronchiectasis typically requires long-term management.

What Causes Bronchiectasis?

Bronchiectasis is caused by damage to the airways from severe respiratory infections (pneumonia, whooping cough, tuberculosis), genetic conditions like cystic fibrosis, immune system disorders, autoimmune diseases, or long-term exposure to harmful substances. In up to 50% of cases, no specific cause can be identified (idiopathic bronchiectasis).

The fundamental cause of bronchiectasis is damage to the airway walls that makes them weak and unable to maintain their normal shape. This damage triggers a "vicious cycle" – damaged airways cannot clear mucus properly, leading to infection, which causes inflammation, which damages the airways further. Understanding what initially started this cycle is important for treatment, though sometimes no cause can be found.

Modern diagnostic techniques have significantly improved our ability to identify underlying causes. Finding a specific cause matters because treating it (when possible) can slow or halt disease progression. For example, if bronchiectasis is caused by an immune deficiency, immunoglobulin replacement therapy can reduce infections dramatically.

Post-infectious causes

Severe respiratory infections remain one of the most common causes of bronchiectasis worldwide. Infections that can damage the airways and lead to bronchiectasis include:

• Bacterial pneumonia: Severe or recurrent pneumonia, especially in childhood, can cause permanent airway damage
• Tuberculosis: A major cause of bronchiectasis globally, particularly in areas where TB is common
• Whooping cough (pertussis): Before widespread vaccination, this was a leading cause of childhood bronchiectasis
• Measles: Particularly when complicated by pneumonia
• Severe viral infections: Including adenovirus and respiratory syncytial virus (RSV)
• Non-tuberculous mycobacteria (NTM): These infections can both cause and complicate bronchiectasis

Genetic and inherited conditions

Several genetic conditions can cause bronchiectasis by affecting mucus production, cilia function, or immune defenses:

• Cystic fibrosis (CF): The most common genetic cause, producing thick, sticky mucus that clogs airways
• Primary ciliary dyskinesia (PCD): A rare condition where cilia don't move properly, preventing mucus clearance
• Alpha-1 antitrypsin deficiency: Can damage lung tissue and airways
• Primary immunodeficiency disorders: Conditions affecting the immune system increase infection risk

Immune system disorders

Problems with the immune system can lead to recurrent infections that damage the airways over time. These include both inherited immunodeficiencies and conditions that develop later in life. People with low levels of immunoglobulins (antibodies) are particularly susceptible to respiratory infections that can cause bronchiectasis.

Autoimmune and inflammatory conditions

Several autoimmune diseases are associated with bronchiectasis, though the exact mechanisms aren't always clear:

• Rheumatoid arthritis: One of the most common autoimmune associations
• Inflammatory bowel disease: Both Crohn's disease and ulcerative colitis
• Sjögren's syndrome: Affects mucous membranes including in the lungs
• Systemic lupus erythematosus: Can cause various lung complications

Airway obstruction

Anything that blocks an airway can cause localized bronchiectasis in the affected area. Common causes include inhaled foreign objects (more common in children), tumors, enlarged lymph nodes, and mucus plugs. If the obstruction is removed early, further damage may be prevented.

Other lung conditions

Chronic lung diseases can contribute to bronchiectasis development:

• Chronic obstructive pulmonary disease (COPD): Many people with COPD also have bronchiectasis
• Severe asthma: Particularly allergic bronchopulmonary aspergillosis (ABPA)
• Aspiration: Repeated inhalation of stomach contents can damage airways

What Are the Symptoms of Bronchiectasis?

The main symptoms of bronchiectasis include a persistent cough that produces large amounts of mucus daily, recurrent chest infections (2-3 or more per year), breathlessness, wheezing, and fatigue. Some people also experience coughing up blood (hemoptysis), chest pain, and joint discomfort. Symptoms typically worsen during exacerbations.

Bronchiectasis symptoms develop because the damaged airways cannot clear mucus effectively, leading to mucus buildup and recurrent infections. The severity of symptoms varies greatly between individuals – some people have mild symptoms that barely affect daily life, while others experience significant disability. Symptoms typically develop gradually over months to years.

Understanding your symptoms helps you recognize when things are getting worse (an exacerbation) so you can seek treatment promptly. Many people find it helpful to keep a symptom diary to track changes and identify triggers.

Cough and sputum production

A chronic cough that produces mucus (sputum) is the hallmark symptom of bronchiectasis. Unlike a normal cough that clears within a few weeks, this cough persists for months or years. The amount and characteristics of sputum provide important information:

• Quantity: Most people produce sputum daily, ranging from a few teaspoons to several cups
• Color: Normal sputum is usually clear or white; yellow, green, or brown sputum often indicates infection
• Consistency: Thick, sticky mucus is harder to clear and may indicate dehydration or infection
• Timing: Many people notice more sputum in the morning after lying flat overnight

The cough may be worse at certain times of day, particularly mornings, or after lying down. Some people find that position changes, such as lying on different sides, help them cough up mucus from specific areas of the lungs.

Recurrent respiratory infections

People with bronchiectasis are prone to chest infections, often called exacerbations. These occur because bacteria thrive in the stagnant mucus. During an exacerbation, you may notice increased cough, more sputum (often changing color), fever, increased breathlessness, and feeling generally unwell. Most people with bronchiectasis experience 2-3 exacerbations per year on average, though this varies widely.

Breathing difficulties

Shortness of breath (dyspnea) is common, particularly during physical activity. It occurs because the damaged airways cannot move air as efficiently as healthy ones. Over time, repeated infections and inflammation can cause scarring that further reduces lung function. Wheezing – a whistling sound when breathing – may also occur, especially during exacerbations.

Hemoptysis (coughing blood)

Coughing up blood can be frightening but is relatively common in bronchiectasis. It usually appears as streaks of blood in the sputum and results from inflamed airways. Small amounts of blood are typically not dangerous, but you should always report hemoptysis to your doctor. Rarely, bronchiectasis can cause massive hemoptysis (large amounts of blood), which is a medical emergency.

Fatigue and general symptoms

Chronic lung disease takes a toll on energy levels. The body expends extra effort to breathe and fight infections, leaving many people feeling constantly tired. Other general symptoms may include unintentional weight loss, loss of appetite, joint pain, and a general sense of not feeling well. These symptoms often improve with better disease control.

How Is Bronchiectasis Diagnosed?

Bronchiectasis is diagnosed primarily through high-resolution CT scan (HRCT), which clearly shows widened airways and is the gold standard test. Additional tests include spirometry to measure lung function, sputum cultures to identify bacteria, blood tests for infection and inflammation, and specific tests to identify underlying causes such as immunoglobulin levels and genetic testing.

Diagnosing bronchiectasis involves confirming the condition is present and then investigating what caused it. The diagnostic process typically begins when someone has symptoms suggesting the condition – particularly a chronic productive cough that doesn't clear with standard treatments, or recurrent chest infections. Early diagnosis is important because prompt treatment can slow disease progression and improve quality of life.

Your doctor will start by asking about your symptoms, medical history, and any relevant family history. They will examine your chest, listening for abnormal sounds like crackles or wheezes. These clinical findings, combined with your history, will guide which tests are needed.

High-resolution CT scan (HRCT)

HRCT is the definitive test for diagnosing bronchiectasis. This specialized CT scan takes thin, detailed slices through your lungs, allowing doctors to see the airways clearly. In bronchiectasis, the scan shows airways that are wider than normal – a key sign is when an airway is wider than the blood vessel running alongside it (the "signet ring" sign). HRCT can also show the type and extent of bronchiectasis, mucus plugging, and signs of infection or inflammation.

Lung function tests (spirometry)

Spirometry measures how well your lungs work by assessing how much air you can breathe out and how quickly. You breathe into a machine that records these measurements. Results are compared to predicted values for your age, sex, and height. Most people with bronchiectasis show an obstructive pattern (difficulty pushing air out) though some may have normal spirometry, especially in mild disease. Regular spirometry helps track disease progression over time.

Sputum tests

Analyzing sputum helps identify which bacteria are present in your airways. This is important because different bacteria require different antibiotics. You will be asked to cough up sputum into a sterile container, which is sent to the laboratory for culture. Results typically take a few days. If you find it difficult to produce sputum naturally, techniques like chest physiotherapy or nebulized saline may help.

Common bacteria found in bronchiectasis include Haemophilus influenzae, Pseudomonas aeruginosa, Moraxella catarrhalis, and Streptococcus pneumoniae. The presence of Pseudomonas is particularly significant as it's associated with more severe disease and may require specific treatment approaches.

Blood tests

Blood tests help identify underlying causes and monitor for infection and inflammation. Common tests include full blood count, inflammatory markers (CRP, ESR), immunoglobulin levels (IgG, IgA, IgM, IgE), specific antibody responses to vaccines, and tests for allergic conditions like ABPA. If cystic fibrosis is suspected, genetic testing and a sweat test may be performed.

Additional investigations

Depending on your symptoms and initial test results, additional tests may be needed:

• Bronchoscopy: A camera passed into the airways to look for abnormalities or take samples
• Nasal nitric oxide: Low levels suggest primary ciliary dyskinesia
• Sweat chloride test: To check for cystic fibrosis
• Tests for autoimmune conditions: If symptoms suggest these as possible causes

How Is Bronchiectasis Treated?

Bronchiectasis treatment focuses on clearing mucus through daily airway clearance techniques, treating and preventing infections with antibiotics when needed, managing underlying causes, and maintaining lung function through exercise and pulmonary rehabilitation. Treatment is individualized based on severity, symptoms, and underlying causes. Surgery is rarely needed but may help in localized disease.

While bronchiectasis cannot usually be cured, effective treatment can control symptoms, reduce infections, prevent further lung damage, and improve quality of life. Treatment is tailored to each individual based on their specific situation – what works best depends on disease severity, underlying causes, symptoms, and personal preferences. A treatment plan developed with your healthcare team should address both daily management and handling of exacerbations.

The goals of treatment are to break the vicious cycle of infection and inflammation, clear mucus from the airways, treat underlying conditions when possible, and prevent complications. Success requires both medical treatments and active self-management.

Airway clearance techniques

Clearing mucus from your airways is fundamental to bronchiectasis management. Daily airway clearance helps prevent mucus buildup, reduces the risk of infections, and can improve breathing. A respiratory physiotherapist can teach you techniques suited to your needs. Common methods include:

• Active cycle of breathing technique (ACBT): A sequence of breathing control, deep breathing, and huffing (forced exhalation) that moves mucus from small to large airways
• Postural drainage: Using gravity by positioning your body to help mucus drain from different lung areas
• PEP (positive expiratory pressure) devices: Breathing out against resistance helps keep airways open and moves mucus
• Oscillating PEP devices: Such as Flutter or Acapella, which add vibrations to help loosen mucus
• High-frequency chest wall oscillation: An inflatable vest that vibrates the chest to loosen mucus

Most people need to do airway clearance at least once daily, with some requiring sessions two or three times daily. Each session typically takes 15-30 minutes. It's important to maintain this routine even when feeling well, as regular clearance helps prevent exacerbations.

Medications

Several types of medications are used in bronchiectasis management:

Mucolytics and airway hydration: Nebulized hypertonic saline (concentrated salt water) helps thin mucus and make it easier to clear. It's typically used before airway clearance sessions. Some people also benefit from mucolytic medications like carbocisteine.

Bronchodilators: Medications that open the airways may help some people breathe more easily and clear mucus more effectively. They're particularly useful if you also have asthma or COPD, or if airway narrowing is present.

Antibiotics: These are essential for treating infections (exacerbations). Treatment usually lasts 14 days, which is longer than for simple chest infections in people without bronchiectasis. The choice of antibiotic depends on which bacteria are present in your sputum. Some people with frequent exacerbations may benefit from long-term antibiotics, either as tablets or nebulized directly into the lungs.

Anti-inflammatory treatments: In certain situations, inhaled corticosteroids or other anti-inflammatory medications may be helpful, particularly if you have coexisting asthma or ABPA.

Treatment of underlying conditions

If an underlying cause of bronchiectasis is identified, treating it can significantly improve outcomes. For example, immunoglobulin replacement therapy for people with antibody deficiencies, antifungal treatment for ABPA, treatment of autoimmune conditions, or removal of airway obstructions. Even when the underlying cause cannot be cured, managing it helps control bronchiectasis progression.

Pulmonary rehabilitation

Pulmonary rehabilitation is a structured program combining exercise training, education, and support. It has been shown to improve exercise capacity, reduce breathlessness, and enhance quality of life in people with bronchiectasis. Programs typically run for 6-12 weeks and involve supervised exercise sessions plus education about managing your condition.

Surgery

Surgery to remove damaged lung tissue is rarely needed but may be considered in specific situations. These include localized bronchiectasis in one area of the lung that causes severe symptoms despite optimal medical treatment, life-threatening bleeding (hemoptysis) that cannot be controlled otherwise, or as preparation for lung transplantation in very severe cases. Surgery is only an option if remaining lung function is adequate.

What Can I Do to Manage Bronchiectasis?

Daily self-management of bronchiectasis includes performing airway clearance techniques every day, staying physically active, not smoking, staying well-hydrated, eating a nutritious diet, getting recommended vaccinations, recognizing early signs of exacerbations, and maintaining contact with your healthcare team. Self-management is essential for controlling symptoms and preventing complications.

Living well with bronchiectasis requires active daily management. While medical treatments are important, what you do every day has an enormous impact on your symptoms and disease progression. Taking control of your health through consistent self-care helps you feel better, have fewer infections, and maintain better lung function over time.

The most important things you can do are perform airway clearance daily, stay active, and respond quickly when symptoms change. Building these habits takes time, but they become easier with practice and can significantly improve your quality of life.

Daily airway clearance

Clearing mucus from your airways every day is the single most important self-care activity. Even when you feel well and aren't producing much mucus, daily clearance prevents buildup and reduces infection risk. Work with a physiotherapist to find techniques that work best for you, and establish a routine that fits your lifestyle. Many people find it helpful to do clearance in the morning (to clear overnight accumulation) and sometimes again in the evening.

Tips for effective airway clearance:

• Use nebulized saline before your session if prescribed – it loosens mucus
• Find a time when you won't be interrupted
• Have tissues or a container ready for sputum
• Stay hydrated – this keeps mucus thinner and easier to clear
• Keep any devices or aids you need clean and accessible

Physical activity and exercise

Regular physical activity improves lung function, helps clear mucus naturally, builds stamina, and improves overall wellbeing. You don't need to run marathons – even moderate activity like walking, swimming, or cycling makes a difference. Start at a level that's comfortable and gradually increase as you're able.

Exercise can actually help with mucus clearance because deeper breathing and movement help mobilize secretions. Some people find that a short walk or other activity is a useful addition to their airway clearance routine. If you're not sure how to start exercising safely, ask about pulmonary rehabilitation or talk to your healthcare team.

Smoking cessation

If you smoke, quitting is one of the best things you can do for your lungs. Smoking damages airways further, impairs mucus clearance, increases infection risk, and accelerates lung function decline. Quitting can be challenging, but support is available through healthcare providers, quitlines, and smoking cessation programs. Even reducing the amount you smoke can help, though complete cessation is ideal.

Nutrition and hydration

Good nutrition supports your immune system and overall health. Eating a balanced diet helps you maintain a healthy weight – being either underweight or significantly overweight can make breathing harder. Some people with bronchiectasis lose weight due to increased energy demands and poor appetite during infections; others may gain weight due to reduced activity.

Staying well-hydrated keeps mucus thinner and easier to clear. Aim for at least 6-8 glasses of fluid daily, more in hot weather or when unwell. Water is best, but other fluids count too. Avoid excessive caffeine and alcohol, which can be dehydrating.

Preventing infections

Reducing your exposure to infections helps prevent exacerbations. Important measures include:

• Vaccinations: Get your annual flu shot and pneumococcal vaccine as recommended. Stay up to date with COVID-19 vaccinations.
• Hand hygiene: Wash hands frequently, especially before eating and after being in public places
• Avoid sick contacts: When possible, stay away from people who have respiratory infections
• Good dental hygiene: Oral bacteria can travel to the lungs, so regular dental care matters

Monitoring your condition

Knowing your body helps you catch problems early. Keep track of your usual symptoms so you can recognize when things are changing. Some people find it helpful to keep a diary noting daily sputum amount and color, breathlessness levels, any new symptoms, and overall energy and wellbeing. This information helps you and your healthcare team make treatment decisions.

When Should I Seek Medical Care?

Contact your healthcare provider if you notice increased cough or sputum, change in sputum color to yellow/green/brown, worsening breathlessness, blood in sputum, fever, or feeling generally unwell. Seek emergency care immediately for severe breathing difficulties, large amounts of coughed-up blood, blue lips or fingertips, or confusion.

Recognizing when your bronchiectasis is getting worse and acting quickly can prevent serious complications. An exacerbation (flare-up) typically involves worsening of your usual symptoms and often requires antibiotic treatment. The sooner treatment starts, the quicker you're likely to recover and the less damage is likely to occur.

Learn to recognize your early warning signs – these are often subtle changes that happen before a full exacerbation develops. Common early signs include slight increases in sputum, feeling more tired than usual, or needing more effort to clear mucus. If you notice these, increase your airway clearance efforts and contact your healthcare team if things don't improve.

Signs of an exacerbation

Contact your healthcare provider promptly if you notice:

• Significantly increased cough or sputum production
• Sputum changing color (especially to yellow, green, or brown)
• New or worse breathlessness
• Blood in your sputum (new or increased)
• Fever or chills
• Feeling generally unwell, tired, or weak
• Chest discomfort or pain

Many people with bronchiectasis have a rescue pack of antibiotics at home, allowing them to start treatment as soon as they recognize an exacerbation. If you have a rescue pack, follow your action plan for when to use it and always contact your healthcare team to let them know you've started treatment.

How Is It to Live with Bronchiectasis?

Living with bronchiectasis varies greatly between individuals. Many people live full, active lives with well-controlled symptoms, while others face more significant challenges. Quality of life depends on disease severity, treatment adherence, and emotional wellbeing. Support from healthcare teams, family, and patient groups can help people manage both physical and psychological aspects of the condition.

Being diagnosed with a chronic condition like bronchiectasis can bring up many emotions – concern about the future, frustration with symptoms, or worry about how it will affect your life. These feelings are normal. Over time, most people find ways to adapt and continue doing the things they enjoy, though some modifications may be needed.

The impact of bronchiectasis on daily life varies enormously. Some people have mild disease that barely affects them, while others have significant symptoms that require substantial management. Either way, understanding your condition and taking an active role in your care helps you feel more in control and typically leads to better outcomes.

Work and daily activities

Most people with bronchiectasis can continue working and doing their usual activities, though some adjustments may be helpful. You might need to plan your day around airway clearance sessions, take more breaks during physical tasks, or make arrangements for when you're having an exacerbation. If your work involves dust, chemicals, or respiratory irritants, discuss this with your healthcare team.

Travel

Travel is generally possible with bronchiectasis, but requires some preparation. Take enough medication for your trip plus extra in case of delays, carry a letter from your doctor explaining your condition and medications, research medical facilities at your destination, consider travel insurance that covers pre-existing conditions, and if flying, ask your doctor whether supplemental oxygen might be needed.

Emotional wellbeing

Living with a chronic condition can affect mental health. Feelings of anxiety, frustration, or depression are common and understandable. The daily management routine can feel burdensome, and symptoms like chronic cough may cause embarrassment in social situations.

It's important to address these aspects of living with bronchiectasis. Strategies that help include learning about your condition (knowledge reduces anxiety), connecting with others who have bronchiectasis through support groups, talking to your healthcare team about how you're feeling, practicing stress management techniques, and staying socially connected.

If you're struggling with low mood, anxiety, or finding it hard to cope, please talk to your healthcare provider. Support is available, and addressing mental health is an important part of managing any chronic condition.

Relationships and family

Bronchiectasis can affect relationships – partners may worry, and symptoms like coughing can be disruptive. Open communication helps. Let those close to you know about your condition, what your symptoms mean, and how they can support you. Family members might also benefit from learning airway clearance techniques to help during exacerbations.

If you're considering pregnancy, discuss this with your healthcare team beforehand. Most women with bronchiectasis can have healthy pregnancies, but some medications may need to be adjusted, and closer monitoring during pregnancy may be beneficial.

What Are the Possible Complications?

Potential complications of bronchiectasis include frequent respiratory infections, respiratory failure in advanced disease, massive hemoptysis (severe bleeding), cardiovascular complications from chronic low oxygen, and reduced quality of life. Proper treatment and self-management significantly reduce the risk of serious complications.

While most people with bronchiectasis do well with proper management, it's important to be aware of potential complications. Understanding these helps you recognize warning signs and understand why ongoing treatment and monitoring matter. The good news is that with current treatments, serious complications have become less common.

Recurrent infections and exacerbations

The most common complication is frequent chest infections. Each exacerbation can cause further airway damage, so minimizing their frequency and treating them promptly is a key goal of management. Some people develop chronic infection with difficult-to-treat bacteria like Pseudomonas aeruginosa, which may require more intensive treatment strategies.

Respiratory failure

In severe or poorly controlled bronchiectasis, lung function can decline to the point where the lungs cannot adequately supply oxygen to the body. This is called respiratory failure. Symptoms include severe breathlessness, confusion, and blue discoloration of lips and fingers. Treatment may include supplemental oxygen or, in severe cases, ventilatory support. This complication is uncommon with good management.

Hemoptysis (coughing blood)

While small amounts of blood in sputum are common and usually not serious, bronchiectasis can occasionally cause massive hemoptysis – coughing up large amounts of blood. This happens when blood vessels in the damaged airways erode. Massive hemoptysis is a medical emergency requiring immediate hospital treatment, which may include procedures to block the bleeding vessels (bronchial artery embolization) or, rarely, surgery.

Other complications

• Cardiovascular effects: Chronic low oxygen levels can strain the heart over time
• Osteoporosis: Chronic inflammation and some medications can affect bone health
• Urinary incontinence: Chronic coughing can weaken pelvic floor muscles
• Nutritional problems: Weight loss from increased energy demands and poor appetite