What is bronchiectasis?
Bronchiectasis is a long-term lung disorder characterised by abnormally widened airways that leave the lungs vulnerable to a build-up of mucus and infection.
The latest estimate is that around 210,000 people in the UK are living with bronchiectasis. In recent years, there has been an increase in the rate of first diagnoses of bronchiectasis in primary care. 33 people for every 100,000 were newly diagnosed in 2012, up from 20 for every 100,000 in 2004 (Source: British Lung Foundation, accessed Jan 2019).
Treatment routes vary depending on the severity of the condition or resulting lung infection, and can include medication, physiotherapy and surgery.
Causes of bronchiectasis
There are a number of things that are believed to cause bronchiectasis. The most commonly reported are lung infections that cause damage to the bronchi and a problem with the immune system that can cause the bronchi to be mistakenly attacked.
However, in the majority of cases there is no obvious or known reason why the bronchi widen. The condition tends to get progressively worse over time.
Symptoms of bronchiectasis
The most common symptom of bronchiectasis is a persistent cough. In three out of four cases the cough will bring up clear, pale yellow or pale green phlegm, while one in four have occasional or no phlegm.
Other common symptoms of the condition include:
- shortness of breath
- chest pain
- coughing up blood
- feeling very unwell.
Symptoms tend to get worse or occur more frequently if a person contracts a lung infection; this is known as infective exacerbation.
At Royal Brompton & Harefield Hospitals Specialist Care, the following consultants offer diagnosis and/or treatment of bronchiectasis to private patients:
- Dr Julius Cairn - Honorary consultant in respiratory medicine
- Dr Felix Chua - Consultant in respiratory medicine
- Dr David Evans - Consultant in respiratory medicine
- Dr Sundeep Kaul - Consultant in critical care and respiratory medicine
- Professor Michael Loebinger - Consultant respiratory physician, Clinical director for laboratory medicine
- Dr Jaymin Morjaria - Consultant in respiratory medicine
- Dr Mark Rosenthal - Consultant in paediatric respiratory medicine
- Professor Robert Wilson - Consultant physician in respiratory medicine.
The first step in the diagnosis of bronchiectasis is to understand the pattern of symptoms and any relevant lifestyle choices, such as whether or not the patient is a smoker.
The clinician will then listen to the patient's lungs using a stethoscope and may take a sample of phlegm for testing.
Chest x-rays are commonly used in the first instance and may be followed up with an high resolution computed tomography (HRCT) scan. These build up a very clear and detailed picture of the lungs and will clearly show if the bronchi have widened.
A blood test may be used to check the efficiency of the immune system. Lastly, a pulmonary function test can measure how quickly and forcefully air can be expelled from the lungs.
Treatment for bronchiectasis
In the majority of cases, bronchiectasis is treated with medication usually administered using a nebuliser and specialist exercises to help clear the mucus that builds up and improve airflow.
When lung infections occur – and sometimes as a preventative measure – antibiotics are usually prescribed.
In a small number of cases, surgery may also be an option.
Steroid-based inhalers can help reduce inflammation, making it easier for bronchiectasis patients to breathe.