Bronchiectasis Symptoms, Causes & Treatment Options

Bronchiectasis is a condition that is caused by many different types of disease processes in which long-standing inflammation or infection leads to thickening of the walls of the bronchi of the lungs. Occasionally, when inflammation recurs or gets worse, individuals with bronchiectasis can get sick and have symptoms of lung illness. This article will review the symptoms causes and treatment of bronchiectasis.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Bronchiectasis?

Summary

Bronchiectasis is a disease caused by long-term inflammation of a part of the lung called the bronchi. Inflammation narrows the bronchi and makes it harder for mucus or bacteria to escape. This causes long-term inflammation and infection which can reduce lung function over a short or long period of time.

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Bronchiectasis Symptoms

Main symptoms

Bronchiectasis usually causes a long-term cough that often produces sputum (spit or phlegm). Individuals with bronchiectasis often have a cough daily over the majority of a year or many years. It can also cause difficulty breathing, chest pain, and a thickening and rounding of the fingers.

  • Cough: A cough from bronchiectasis is usually productive of phlegm, spit, or mucus and occurs almost every day. It happens even when there is no infection and is caused by whatever causes the underlying inflammation of the lungs in addition to any infection or other causes of inflammation.
  • Shortness of breath: Because of the narrowing of the bronchi in the lungs, it is common to hear wheezing or whistling when an individual with bronchiectasis breathes. This is because the bronchi which are usually wide are narrowed and that narrowing makes it more difficult for air to flow in and out of the lung. As that air flows through a thin tube, it causes a wheezing sound and the affected individual has to work harder to move air out of his or her lung.
  • Chest pain: Bronchiectasis causes chest pain from infection and damage to the lung. The inflammation that occurs can sensitize nerves in the lungs leading to an increase in chest pain. Additionally, if pneumonia develops, chest pain is not an unusual occurrence.
  • Clubbing: When an individual has bronchiectasis and stops being able to move oxygen effectively because of mucus blocking the bronchi, the lack of oxygen causes a reaction in the body that leads to thickening of the tissue underneath the fingernails.
  • Respiratory failure: Over a long time, as lung tissue is damaged and destroyed by inflammation and repeated infection it can gradually decrease lung function to the point where an individual is unable to breathe and provide enough oxygen to their body to provide for their body’s needs. In some cases, this can cause individuals with severe or longstanding bronchiectasis to need oxygen to support their breathing, to need intubation, or in very severe cases to consider a lung transplant.
  • Atelectasis: Because the mucus often closes off small air passes in the lungs as they are clogged with either mucus, bacteria, or narrowed by infection, it can cause those areas without air to be unavailable for providing oxygen to the lung. The term “atelectasis” refers to these non-aerated portions of the lung. On a chest X-ray, because these portions of the lung do not have oxygenation, they are often darker-appearing.
  • Heart failure: In long-standing and extreme cases, the blockage of bronchi over time can cause the pressure needed to pump blood into the lungs to increase. Over time, this increase in pressure can cause the muscles of the heart to grow larger and the empty space within the heart to decrease (because the walls of the heart have thickened). As the heart chamber becomes smaller, it is able to move less blood and blood begins to back up into other areas of the body like the lungs or the blood vessels of the liver. This is known as heart failure.

Bronchiectasis Causes

Bronchiectasis is caused by long-standing inflammation, mucus blockage of the lungs, or infections of the lungs. Most commonly bronchiectasis that is caused by infections is caused by severe pneumonia, whooping cough, tuberculosis, or fungal infections. Additionally, genetic conditions can also cause bronchiectasis. Bronchiectasis can also be caused by diseases that decrease the body’s ability to clear mucus by thickening it or weakening the structures that help remove it, decrease immune function, or introduce sources of infections repeatedly. Each of these causes will be covered in a category below.

Infection

Infections that are difficult to treat, cause large amounts of inflammation, or take a long time to be successfully treated can cause changes to the bronchi of the lungs that lead to bronchiectasis. The most common or well-known infection causes are listed below. Common infectious causes include tuberculosis. Even in healthy individual’s tuberculosis can cause low-level infection and when an individual is weakened by age or immunocompromised (e.g., AIDS, chemotherapy), tuberculosis may cause more severe infections or aggravate bronchiectasis.

  • Tuberculosis: Even in healthy individual’s tuberculosis can cause low-level infection and when an individual is weakened by age or immunocompromised (e.g., AIDS, chemotherapy), tuberculosis may cause more severe infections or aggravate bronchiectasis.
  • Fungal infections: Fungal infections can affect individuals who live in areas with many fungal spores or individuals who visit areas with many airborne spores (e.g., caves with bats).
  • MRSA pneumonia: Pneumonia caused by MRSA can cause large amounts of pus or mucus to accumulate in the lungs causing the symptoms of bronchiectasis. It is uncommon for healthy individuals to develop an infection with MRSA. Often MRSA infections develop in individuals who have difficulty avoiding food entering their airway or have reduced ability to clear mucus.
  • Severe pneumonia: Severe pneumonia, if it develops, can cause scarring and inflammation that can lead to bronchiectasis in the affected part of the lung.
  • Whooping cough: Whooping cough can cause long term inflammation that can lead to narrowing of the bronchi and lead to increased accumulation of mucus within the lungs.

Immunosuppression

Individuals who have a reduced ability to destroy naturally occurring bacteria in the lungs, like those that occur when individuals aspirate or inhale saliva or oral secretions, may develop severe lung infections that over time may lead to bronchiectasis.

  • HIV/AIDS: Generally, an HIV infection does not mean that an individual is immunosuppressed. AIDS or Acquired Autoimmune Deficiency Syndrome occurs when HIV is untreated or unsuccessfully treated, and limits the body’s immune system. If this occurs, severe infections including pneumonia can occur, cause inflammation, scarring, and predispose an individual to bronchiectasis.
  • Chemotherapy: Individuals undergoing chemotherapy or taking other medications that can limit immune function are at higher risk for severe lung infections which in turn can lead to scarring and bronchiectasis.

Mucus Clearance

The lungs will often trap bacterial that slips through the vocal cords and epiglottis in a thin mucus and use small hair-like projections called “cilia” to carry the bacteria trapped in the mucus out of the airway. If the “mucociliary escalator” or the combination of the cilia and the thin mucus is not functioning correctly, it can lead to an accumulation of thick mucus that traps bacteria in the lungs leading to persistent pneumonia.

  • Cystic fibrosis: Cystic fibrosis is a disease which causes among other things, a thicker mucus in the lungs. This mucus is difficult to move for the “cilia” of the lungs. This causes an accumulation of mucus that can lead to trapping of bacteria, infection, and prevention of oxygenation for some areas of the lungs.
  • Primary ciliary dyskinesia: In ciliary dyskinesia, some of the cilia do not function correctly. This is frequently due to a mutation in the lung. If the cilia do not function correctly, even though the mucus is normal, the walls of the bronchi may be unable to adequately move mucus leading to trapping of bacteria and an inability of oxygen to reach some areas of the lungs.

Recurrent Infection

Repeated infections of the lungs are common in individuals who cannot “protect their airway.” The body has a flap of cartilage called the epiglottis that seals off the airway when swallowing to keep food from entering the lungs. It can also protect the airway during regurgitation. For individuals who have lost the function of their epiglottis either through surgery, stroke, or other injury, food or saliva carrying bacteria can enter the lungs and cause chronic (or long term) infection, scarring, and trapping of mucus and bacteria leading to bronchiectasis.

  • Aspirational pneumonia: Individuals who have lost the function of their epiglottis have an increased rate of aspirational pneumonia and mucus plugging in the lungs.
  • Stroke: Stroke can lead to impairment of the epiglottis and a higher chance of aspirational pneumonia.

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Treatment Options, Relief, and Prevention for Bronchiectasis

Treatment

Treatment depends on the cause of bronchiectasis and which areas of the lung it affects. Generally, bronchiectasis is treated by remedying the underlying cause of bronchiectasis and by treating the prevailing symptoms and medically supporting an individual through a flare.

  • Immunosuppression: Underlying cause of immunosuppression should be identified and treated. Stopping offending medications, treating diseases like HIV, or adjusting chemotherapy are all potential therapeutic approaches.
  • Mucus accumulation: Mucus accumulation can be treated through means of removing mucus including, aerosolized hypertonic saline, chest physical therapy or cupped hand taps to loosen mucus.
  • Respiratory failure: Difficulty breathing from long term bronchiectasis can be eased through oxygen but cannot be reversed.
  • Infection: Depending on the severity of pneumonia, the health of the person affected, and the resistance of the infection to antibiotics the physician may decide to treat a long-standing infection with either oral or IV antibiotics

Prevention

Individuals predisposed to infection should take medications necessary to either reduce mucus buildup or avoid immunosuppression or treat for infection early in the treatment process. Individuals with cystic fibrosis may need routine hypertonic saline administrations and chest physical therapy. Individuals with HIV should maintain a healthy CD4 T cell count by continuing treatment with proper antiviral medications.

When to Seek Further Consultation for Bronchiectasis

If you have difficulty breathing or catching your breath, you should seek medical attention. If you have a fever, chills, or elevated temperature, you should seek further evaluation. If you have consistent production of sputum or a long-standing pneumonia, you should seek evaluation.