Understanding Bronchiectasis

Bronchiectasis is an under-diagnosed disease that can cause devastating lung damage.

It affects the walls of the large airways of the lung, slowly destroying the muscles and the elastic tissues that line the bronchial tubes. Normal airways are built to contract and funnel mucus out of your lungs. But when the airways become distorted and scarred by repeated infections, they can no longer clear out normal secretions. Mucus accumulates, forming a breeding ground for bacteria and inflammation, which causes further damage. As the disease progresses, it creates irregularly shaped pockets in the airways. Those pockets can become a home for more infections.

Bronchiectasis increases with age. Fewer than 1 out of 20,000 people age 18 to 34 have the disease. But that rises to about one in 350 people by age 75. A 2005 study estimated that 110,000 people in the U.S. are treated for bronchiectasis each year. Another study found that hospitalization for bronchiectasis has been increasing by more than five percent a year since 2001.

Symptoms include a cough that never goes away and increased production of sputum, which is also known as phlegm. Some patients have frequent pneumonia. As your lung function decreases, you may also have shortness of breath and find you're increasingly tired. Advanced disease can lead to heart failure.

Although your medical history can indicate probable bronchiectasis, doctors often definitively diagnosis bronchiectasis using a high-resolution CT scan. These detailed images can show if there's been thickening of the walls of your bronchial tubes and whether you have the misshapen, damaged or collapsed airways. Pulmonary function studies can assess the type and severity your disease and measure the benefits of treatment.

Treating Bronchiectasis

Bronchiectasis can't be cured, but it can be treated.

Treatment is based on clearing mucus from your lungs, preventing infections and reducing inflammation. With proper treatment, most people with this disease live a normal life. The sooner the disease is detected and treated, however, the better the chance is of preventing serious damage to your lungs.

Living with this disease process requires diligence and commitment. One mainstay of treatment, clearing mucus out of the lungs, is often compared to "forcefully emptying the last remnants from a ketchup bottle." It combines postural drainage (placing the head lower than the chest) with chest percussion (thumping over the lungs to dislodge pooled secretions).

Patients with bronchiectasis are also encouraged to drink lots of fluids and to exercise frequently to help clear their lungs and maintain cardiovascular health. Many patients also benefit from frequent antibiotic use, often delivered directly to the lungs with a nebulizer, a drug delivery device that transforms medications into a mist that is then inhaled into the lungs. Your doctor may also prescribe medications to dilute mucus, dilate your airways and decrease inflammation.

Surgery may be an option for some patients. Cutting out a damaged airway can help, or removing part of the lung that acts as a reservoir for frequent infections. A lung transplant may be considered in severe cases.

Bronchiectasis can develop at any age. It begins most often in childhood, but symptoms may not appear until much later.

There is usually an underlying medical condition, an inherited disease such as cystic fibrosis, or an environmental trigger such as exposure to caustic fumes, a major lung infection or a blocked airway. While there are many possible causes of bronchiectasis, there also are more and more treatment options available.