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    Bronchiectasis

    Acquired bronchiectasis; Congenital bronchiectasis

    Bronchiectasis is destruction and widening of the large airways.

    • If the condition is present at birth, it is called congenital bronchiectasis.
    • If it develops later in life, it is called acquired bronchiectasis.

    Causes

    Bronchiectasis is often caused by recurrent inflammation or infection of the airways. Sometimes it begins in childhood after a more severe lunginfection or inhaling a foreign object.

    Cystic fibrosis causes about a third of all bronchiectasis cases in the United States. Certain genetic conditions can also cause bronchiectasis, including primary ciliary dyskinesia and immunodeficiency syndromes.

    The condition can also be caused by routinely breathing in food particles while eating.

    Symptoms

    Symptoms often develop gradually, and may occur months or years after the event that causes the bronchiectasis.

    They may include:

    • Bluish skin color
    • Breath odor
    • Chronic cough with large amounts of foul-smelling sputum
    • Clubbing of fingers
    • Coughing up blood
    • Cough that gets worse when lying on one side
    • Fatigue
    • Paleness
    • Shortness of breath that gets worse with exercise
    • Weight loss
    • Wheezing

    Exams and Tests

    When listening to the chest with a stethoscope, the doctor may hear small clicking, bubbling, wheezing, rattling, or other sounds, usually in the lower lobes of the lungs.

    Tests may include:

    • Aspergillosis precipitin test (to check for signs of the aspergillosis fungus)
    • Alpha-1 antitrypsin blood test
    • Chest x-ray
    • Chest CT
    • Sputum culture
    • Complete blood count (CBC)
    • Genetic testing, including sweat test for cystic fibrosis
    • PPD skin test to check for a prior tuberculosis infection
    • Serum immunoglobulin electrophoresis

    Treatment

    Treatment is aimed at controlling infections and bronchial secretions, relieving airway obstruction, and preventing complications.

    Regular, daily drainage to remove bronchial secretions is a routine part of treatment. A respiratory therapist can show the patient coughing exercises that will help.

    Antibiotics, bronchodilators, and expectorants are often prescribed for infections.

    Surgery to resect the lung may be needed if medicine does not work or if the patient has massive bleeding.

    Outlook (Prognosis)

    The outlook depends on the specific cause of the disease. With treatment, most people can lead normal lives without major disability.

    Possible Complications

    • Cor pulmonale
    • Coughing up blood
    • Low oxygen levels (in severe cases)
    • Recurrent pneumonia

    When to Contact a Medical Professional

    Call your health care provider if:

    • Chest pain or shortness of breath gets worse
    • There is a change in color or amount of the phlegm you cough up, or if it is bloody
    • Other symptoms get worse or do not improve with treatment

    Prevention

    The risk may be reduced if lung infections are promptly treated.

    Childhood vaccinations and a yearly flu vaccine help reduce the chance of some infections. Avoiding upper respiratory infections, smoking, and pollution may also reduce your risk of infection.

    References

    Iseman MD, Chan ED. Bronchiectasis. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 42.

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    • Lungs

      illustration

    • Respiratory system

      illustration

      • Lungs

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      • Respiratory system

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      Tests for Bronchiectasis

        Review Date: 8/30/2012

        Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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