Bronchiectasis; causes, treatment and prevention.

Written by: Dr Shanthi Paramothayan
Edited by: Lisa Heffernan

Bronchiectasis is a chronic lung disease that affects the small airways in the lungs. It results from inflammation and the destruction of the airways, most commonly due to recurrent respiratory infections, leading to dilation of the small airways.

Top Doctor Shanthi Paramothayan speaks about this condition in detail and what can be done for patients suffering from the disease. 



What causes bronchiectasis?

Bronchiectasis can be caused by many different factors.  Some of these are genetic, for example, cystic fibrosis and others, also inherited, are rare, for example, conditions that affect the cilia(hair-like structures that sweep mucus out of the lungs), which line the bronchi. Patients with weak immune systems are also at increased risk. The most common cause of bronchiectasis is recurrent respiratory tract infections, often in childhood, which damage the airways. Patients with asthma who are prone to recurrent infections can develop bronchiectasis. Other causes include previous tuberculosis infections, foreign body inhalation and rheumatoid arthritis.

What are the symptoms?

The symptoms of bronchiectasis are a persistent, daily, productive cough, occasionally with blood in it, breathlessness, and recurrent chest infections. In severe cases of bronchiectasis, patients may complain of fatigue and weight loss.

Who is most at risk?

Patients who are at risk are those who suffer from frequent respiratory tract infections, those with immune deficiency and those with an inherited condition, for example; cystic fibrosis, primary ciliary dyskinesia and alpjha-1 antitrypsin deficiency. Patients who have those conditions mentioned above are at increased risk.

How can it be treated?

Bronchiectasis cannot be cured but further damage can be prevented. Once the diagnosis of bronchiectasis is made, usually by a high-0resolution CT scan of the thorax (HRCT), it is important to identify the underlying cause of the bronchiectasis, even if it cannot be corrected. Management involves inhalers that dilate the bronchi and reduce inflammation, a medication called mucodyne to make the secretions thinner and easier to cough up, and chest physiotherapy (called postural drainage) to clear all the secretions. Patients should be given antibiotics without delay when they develop a chest infection to limit the damage done. Patients acquiring frequent infections will be given prophylactic antibiotics, for example, Azithromycin, to take two or three times a week.

Are there any ways to prevent it?

Early identification is the best way to prevent progression of the condition. Patients who have symptoms suggestive of bronchiectasis, for example; frequent chest infections and those who cough up mucus daily, should be investigated with an HRCT, blood tests for immune function, sputum (a mixture of saliva and mucus) analysis and lung function tests.

It is essential to ensure that these patients do daily postural drainage exercises to clear their lungs, do breathing exercises to clear the lungs and receive antibiotics promptly for any infection. It is recommended that patients with bronchiectasis have a supply of antibiotics at home to take as soon as they develop symptoms of a chest infection.

If you experience persistent chest infections, coughing and are in the at-risk group for bronchiectasis, see a specialist for advice and support. 

Dr Shanthi Paramothayan

By Dr Shanthi Paramothayan
Pulmonology & respiratory medicine

Dr Shanthi Paramothayan is one of London's leading consultants in respiratory and general medicine. Well-respected in her field, she specialises in asthma, chronic obstructive pulmonary disease (COPD) and lung cancer.

Dr Paramothayan is committed to education and training of medical students and junior doctors, and was an honorary senior lecturer at St George's University of London and associate Dean (foundation) for Health Education South London. In addition to these roles she is a member of a number of associations and has contributed to many publications.

Dr Paramothayan has conducted several Cochrane systematic reviews, is an examiner for the Royal College of Physicians and a member of MRCP Part 1 board, she is an active member of the British Thoracic Society, having contributed to the education and training committee and a professional and organisational committee member.

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