Bronchiectasis

What is bronchiectasis?

• Bronchiectasis (bron-key-ECK-tah-sis) is a lung condition where your bronchi get too wide and mucus builds up in them. Your bronchi are medium-sized airways (tubes that carry air in and out of your lungs). Your lungs make mucus to trap and remove germs and irritants that you breathe in. The mucus made in your lungs is also called phlegm (flem). Your airways are lined with ciliated cells that help move the mucus out of your lungs. The cilia (SIL-ee-ah) are fine, hair-like structures on the cells that move back and forth. These special cells sweep the mucus upward in your airways to move it out of your lungs.
  
  
• With bronchiectasis, your lung airways get damaged and cannot clear out the mucus the way they should. The mucus stays in the airways and germs grow in it, causing new and repeated lung infections. Over time this can cause your airways to swell, stretch out, and scar, making it harder for you to move air through them. This long-lasting damage can happen to one or many parts of your lungs. Once this damage happens, treatment is aimed at preventing more damage from infections. This may help to prevent your symptoms from getting worse.

What causes bronchiectasis?

Bronchiectasis is caused by having repeated infections and inflammation (swelling) in your lungs. Inflammation leading to bronchiectasis can be caused by diseases that affect the lungs and by past lung infections. Other causes include asthma, allergies and other immune system problems, and things that irritate or block your airways. The exact cause of your bronchiectasis is not known. Bronchiectasis is a type of chronic obstructive pulmonary disease (COPD). Ask your caregiver for more information about COPD.

What may increase my risk of having bronchiectasis?

• Chemical damage: Breathing in harmful fumes or having acid reflux (GERD) from your stomach may cause damage to your airways.
  
  
• Immune system problems: The immune system is your body's defense against certain diseases and infections. When the defense system is weak, as with HIV infection or AIDS, your risk of getting lung infection increases. When your immune system is over-active, it can attack your lung tissues and cause inflammation. This can happen if you have allergies, rheumatoid arthritis (RA) or inflammatory bowel disease (IBS).
  
  
• Inherited diseases: You may have been born with genes that cause certain lung problems. A gene is a little piece of information which tells your body what to do or make. Genes are passed on by a parent to a child. Cystic fibrosis (CF) is a disease that often causes bronchiectasis. Ask your caregiver for more information about cystic fibrosis.
  
  
• Obstruction: This may happen if you breathe in small pieces of food while you are eating. These can get stuck in your airways. Tumors (lumps) in your chest may grow big and block your airway.
  
  
• Other diseases: Having a disease that causes the ciliated cells not to work well can lead to bronchiectasis. The disease can decrease your body's way of clearing out mucus from your airways.
  
  
• Past lung infections: Having lung infections during your childhood or later can cause lasting damage to your airways. These may increase your risk of having bronchiectasis. These infections include measles, whooping cough, tuberculosis, and pneumonia.

What are the signs and symptoms of bronchiectasis?

• When you first get bronchiectasis:
  
  
  • Body weakness or getting tired easily.
    
    
  • Frequent, ongoing cough that may or may not bring up phlegm.
    
    
  • Runny nose and sinus drainage.
    
    
  • Shortness of breath, or having wheezes (high-pitched sound) while breathing.
    
    
  • Weight loss.
  
  
• After you have had bronchiectasis for a time:
  
  
  • Chest pain.
    
    
  • Clubbing of your fingers or toes. Clubbing is when the ends of your fingers or toes become round and thick. This happens when your body does not get enough oxygen over a very long time.
    
    
  • Coughing more than usual with large amounts of phlegm.
    
    
  • Coughing up blood or phlegm that contains blood.
    
    
  • Coughing up dark or bad-smelling phlegm.
    
    
  • Loss of appetite and feeling unwell.

How is bronchiectasis diagnosed?

Your caregiver will ask about your symptoms and how bad they are. He will ask about your medical history. He may need to know what medicines you are taking. He may ask if you have allergies or lung infections that go away for a time, and then come back. He will do a physical exam on you. You may also have any of the following tests:

• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• High resolution computed tomography scan: This test is also called a CT scan or HRCT scan. A special x-ray machine uses a computer to take pictures of your chest and airways. It may also be used to look at other body parts such as bones, tissues, or blood vessels.
  
  
• Pulmonary function tests: Pulmonary function tests (PFTs) help caregivers learn how well your body uses oxygen. You breathe into a mouthpiece connected to a machine. The machine measures how much air you breathe in and out over a certain amount of time. PFTs help your caregivers decide the best treatment for you.
  
  
• Sputum sample: Sputum (mucus from your lungs) is collected in a cup when you cough. The sample is sent to a lab to be tested for the germ that is causing your illness. It can also help your caregiver choose the best medicine to treat the infection.

How is bronchiectasis treated?

There is no cure for bronchiectasis. Your caregiver will work with you to improve your symptoms and prevent lung infections and more airway damage. You may have any of the following treatments:

• Medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Anti-inflammatory drugs: This family of medicine is also known as non-steroidal anti-inflammatory drugs or NSAIDs. They may help decrease pain and inflammation (swelling). This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
    
    
  • Bronchodilators: You may need bronchodilators to help open the air passages in your lungs, and help you breathe more easily.
    
    
  • Expectorants: Expectorant medicine helps thin your sputum (mucus from the lungs). When sputum is thin, it may be easier for you to cough it up and spit it out. This may make your breathing easier, and may help you get better faster.
    
    
  • Immune globulins: This medicine is given as a shot or an IV infusion to make your immune system stronger. You may need immune globulins to treat or prevent an infection. It is also used when you have a chronic condition, such as lupus or arthritis. You may need many weeks of treatment. Each infusion can take from 2 to 5 hours.
    
    
  • Steroids: Steroid medicine may help to open your air passages so you can breathe easier. Do not stop taking this medicine without your caregiver's OK. Stopping on your own can cause problems.
  
  
• Oxygen: You may need to use extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Surgery: This removes the damaged part of your lung that is causing your symptoms. This is done if treatment with medicines failed. You may also need a lung transplant if your symptoms become very bad. In some cases, your whole lung is replaced with a healthy lung from someone else (a donor). Ask your caregiver for more information about this treatment.

What can I do to help me breathe more easily?

You can learn ways to help loosen mucus in your airways so you can more easily cough it up. There are many different types of airway clearance techniques (ACTs) that you can use. Ask your caregiver to help you decide on the ACT program that is best for you, and how often you need to do it. Doing ACT's regularly over time can help decrease your symptoms.

• Breathing techniques:
  
  
  • Controlled breathing: Controlled breathing is when you practice breathing gently, slowly, and deeply. You may also need to breathe out air as fast as you can, which will help force mucus out of your airways.
    
    
  • Chest expansion exercises: Chest exercises help you completely fill your lungs with air by letting your abdomen swell as you breathe in.
    
    
  • Forced expiration technique: Coughing is a forceful response to something irritating your airway. Huffing is less forceful and tiring, and can be done instead of coughing. It is a controlled, less forceful pushing out of breath with your diaphragm and chest muscles. The diaphragm is the large muscle at the bottom of your chest that helps you breathe.
  
  
  
  • Lung drainage: This is a method that can be used to bring up mucus from lower parts of your airways or lungs. In this exercise you sit up straight and slowly breathe in through your nose to fill your lungs. You then hold your breath for 3 to 4 seconds, and breathe out as fast as you can through your nose. You may need to repeat this exercise several times to push out the mucus.
    
    
  • Chest physical therapy:
    
    
    • Percussion: This involves having another person forcefully pat on your back with a cupped hand or soft plastic cup. It is done to loosen mucus stuck in your airways. Percussion may also be done with an electric percussor.
      
      
    • Postural drainage: This therapy is designed to help drain mucus from different parts of your lung. Your caregiver will show you the body positions to be in for this therapy.
  
  

• ACT with equipment:
  
  
  • High frequency chest wall oscillation: This therapy uses a special vest that you wear. It attaches to a machine that causes the vest to vibrate your chest.
    
    
  • Oscillating positive end pressure therapy: This method uses a small, pocket-sized device that works by vibrating your airways as you breathe out through it. You will need to breathe in and fill your lungs, and hold your breath for 2 to 3 seconds. You then put the device tightly to your mouth and breathe out normally through it.
    
    
  • Positive expiratory pressure therapy: PEP therapy uses a device that keeps some air in your airways when you breathe out. This helps prevent mucus from getting trapped in your small airways, making it easier to cough up.
  
  

What can I do to prevent my bronchiectasis from getting worse?

• Colds or the flu: Stay away from people who have colds or the flu. Ask your caregiver if you should get shots to keep from getting the flu and pneumonia. Also try to stay away from large groups of people. This decreases your chance of getting sick.
  
  
• Smoking: It is never too late to stop smoking. Smoking harms your heart, lungs, and blood. It can irritate your airways and make your condition worse. You are more likely to have a heart attack, lung disease, or cancer if you smoke. You will help yourself and those around you if you stop smoking. Ask your caregiver for more information about how to stop smoking if you have trouble quitting.
  
  
• Vaccines: To prevent influenza (flu), all adults should get the influenza vaccine. They should get it every year as soon as it becomes available. The pneumococcal vaccine is given to adults aged 65 years or older to prevent pneumococcal disease, such as pneumonia. People aged 19 to 64 years at high risk for pneumococcal disease also should get the pneumococcal vaccine. It may need to be repeated 5 years later.

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You are coughing more than usual, wheezing, and have trouble breathing.
  
  
• You find it hard to do your daily activities because of wheezing, coughing, or other symptoms.
  
  
• Your medicines do not relieve your symptoms as well as they used to.
  
  
• You have any questions or concerns about your medicine, condition, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You are coughing up blood.
  
  
• You have trouble breathing all of a sudden.
  
  
• You have trouble thinking, are confused, or have just fainted.
  
  
• You have sudden chest pain.
  
  
• Your lips or fingernails are turning gray or blue.

Where can I find more information?

Having bronchiectasis can be hard for you and your family. Learning more about bronchiectasis can help you understand how to deal with your condition. Contact the following for more information:

• American Lung Association
  1301 Pennsylvania Ave. NW
  Washington , DC 20004
  Phone: 1- 202 - 785-3355
  Phone: 1- 800 - 548-8252
  Web Address: www.lung.org
  

• National Heart, Lung and Blood Institute
  Health Information Center
  P.O. Box 30105
  Bethesda , MD 20824-0105
  Phone: 1- 301 - 592-8573
  Web Address: http://www.nhlbi.nih.gov/health/infoctr/index.htm
  

• National Jewish Medical and Research Center
  1400 Jackson Street
  Denver , CO 80206
  Phone: 1- 800 - 222-5864
  Web Address: http://www.nationaljewish.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Bronchiectasis