Bronchiectasis (bron-kee-eck-tuh-sis) is a lung condition that causes cough, sputum production, and recurrent respiratory infections. The symptoms are caused by abnormal dilation (widening) of the airways of the lung (bronchi). In some cases only one airway is affected. In other cases, many are affected. In very severe cases, dilation of the airways occurs throughout the lungs. This dilation makes it difficult to bring up secretions (sputum, phlegm, mucus) from the lower airways. These sticky secretions provide an ideal place for many kinds of germs to live and grow. This leads to infection and overgrowth of bacteria which leads to inflammation (swelling and irritation). Infection and inflammation further damage the airways and cause more dilation and worsening bronchiectasis. This process is sometimes called the “vicious cycle hypothesis” of bronchiectasis.
There are many causes of bronchiectasis, including:
- genetic diseases (such as cystic fibrosis and primary ciliary dyskinesia)
- problems with the immune system (reduced ability to fight infections)
- past lung infections
- problems with swallowing causing aspiration of food or fluids into the lungs or accidentally breathing in stomach acid that has come up your child’s food tube
- severe infections such as pneumonia, tuberculosis or whooping cough -this is the most common known cause
- a problem with the way your child’s lungs grew in the first place
- a blockage caused by something your child inhaled, such as a small nut
It’s important to try and find out how their airways were damaged. This can help with treatment and preventing more damage. But for about 40% of children and adults, there is no clear cause for their bronchiectasis. These cases are called “idiopathic bronchiectasis.”
It’s not always possible to prevent the lung damage that causes bronchiectasis. But you can do lots of things to reduce the risks to your child’s lungs.
The most common symptom of bronchiectasis is cough, which is usually productive of sputum (phlegm). The cough may become worse at times, and a person may also have fever, chills, night sweats, tiredness, and a change in the color and amount of sputum. When this happens it is called an exacerbation (or flare-up) of bronchiectasis. Other symptoms can include:
- Shortness of breath or air hunger
- Unintended weight loss
- Coughing up blood (hemoptysis)
- Chest pain or tightness
If your child has been diagnosed with asthma but this has not got better with treatment or they have lots of chest infections with green or yellow mucus, they may have bronchiectasis.
Bronchiectasis is diagnosed by x-ray imaging, almost always with a CT of the chest (CAT scan). The CT scan will show the location and severity of the bronchiectasis, and may give clues about its cause. Your doctor may also order lung function (breathing tests) and cultures of your sputum to look for specific germs. These cultures will help determine which antibiotics will be most effective during exacerbations. In some cases your doctor may order a bronchoscopy (bronck-ah-sko- pee), in which a long tube with a light and camera on the end is placed into your airways to retrieve mucus
They may also do other tests to try and find out how your child’s lungs were damaged. These might include:
- tests on your child’s mucus to find out if bacteria are present
- blood tests to check your child’s immune system
- a brushing of the inside of your child’s nose to check if the hair-like structures on airway cells called cilia are working properly
- a procedure to look into your child’s lungs using a small camera on the end of a tube called a bronchoscope
- tests on your child’s sweat to see if they have cystic fibrosis
Bronchiectasis is a condition that usually develops over time, and worsens with repeated infections. Therefore the goals of treatment are preventing infections and exacerbations. It is important to try to help the lungs stay as healthy as possible with good lung function. You should contact your doctor without delay if you develop symptoms of an exacerbation. By sticking with the treatments prescribed by your doctor, you have the best chance of controlling this condition and keeping it from getting worse.
The main aims for treatment are to move mucus out of the lungs and to treat any infection quickly.
Your doctor will help you figure out the best treatment plan for you. There are two important parts of bronchiectasis treatment:
- Maintenance: What you do every day. This usually includes airway clearance, changes in your lifestyle, and other actions you can take to prevent infections and lung damage.
- Exacerbations (eg-zass-er-bay-shuns): What you do when you get sick and have a change in symptoms. This usually includes increasing airway clearance and taking antibiotics to treat infection.
Antibiotics
Antibiotics are used to treat infections. Your child may have to take them for longer than usual (2 weeks or more) when they have an infection. If your child keeps getting infections then your doctor might recommend that they take a low dose of antibiotics all the time.
If your child has to take a lot of antibiotics they may use a nebuliser. A nebuliser makes the medicine into a mist that is breathed in through a face mask. It helps direct the medicine into your child’s airways.
Your child may be given an inhaler to help relax and open their airways.
Physiotherapy
Physiotherapy is one of the most important ways of managing bronchiectasis in children. A physiotherapist will show you how to do it.
Physiotherapy helps to clear mucus that is too far down to cough up. This helps to clear the chest of infection and helps to prevent further damage. You carry on doing it even if your child’s cough goes away.
Your child’s physiotherapist may use inhaled saline to help clear mucus. Parents have told us that when their children take a saline solution through a nebuliser before each session of physiotherapy, it’s helped.
Depending on how severe your bronchiectasis is and how much mucus is produced in your airways, your doctor may suggest that you learn to do one or more of the following:
Airway Clearance Methods
- chest physiotherapy involves chest clapping in various positions to move mucus up to the windpipe so that you can cough it out.
- handheld positive expiratory pressure (PEP) devices are used to loosen mucus by creating vibration while breathing through the device.
- percussion devices which can include mechanical percussors and percussive vests (high frequency chest wall oscillation) are used to loosen mucus and move it to the windpipe to cough out.
All forms of airway clearance depend on good coughs to move loose mucus out. You can learn techniques to improve your cough strength and effort. You want to bring mucus up and out of the lungs!
Coughing Technique
During and after your airway clearance routine, you can use your cough to bring up the loosened phlegm. The most common cough technique is called the “huff cough.” It is similar to breathing fog onto your glasses to clean them: start by taking a deep breath through your nose. Exhaling in 3 equal breaths, pull your belly inward to force the air from your lungs while making a “huff” sound in the back of your throat. Repeat this 2-3 times during and after your airway clearance routine
Inhaled (nebulized) Medications
Medicines may be inhaled to help open the airways and loosen mucus. A bronchodilator such as albuterol or levalbuterol can help relieve or prevent spasm of the airway muscles. Hypertonic saline is a concentrated salt water solution that can help loosen secretions in your airways. Often inhaled medicines are used before or during airway clearance to help bring mucus up
While bronchiectasis is a long-term condition, you may occasionally become more ill. This is called an acute exacerbation. Often this is due to a new respiratory infection or overgrowth of bacteria that are chronic.
It is important to recognize the following signs and symptoms of an exacerbation:
- Increased sputum production, and/or change in color
- Blood in sputum
- Fever
- Increased tiredness
- Worsening shortness of breath
- Unintentional weight loss, lack of appetite
If you develop any of these symptoms, contact your doctor right away (promptly). You can increase your airway clearance to help get the extra mucus up. You may need antibiotics to treat the infection. Remember that repeated exacerbations can cause bronchiectasis to worsen over time
- Stay hydrated by drinking plenty of water. If you become dehydrated the mucus will also become dehydrated, making it thick and sticky.
- Exercise regularly. Jogging, biking, or brisk walking helps loosen mucus in the chest, keeping your airways clear of secretions. Regular exercise decreases exacerbations and improves quality of life in patients with bronchiectasis.
- If you smoke, stop. It is also important to avoid exposure to smoke and other air pollutants.
- Get your yearly flu shot
- Eat well. Maintain a healthy weight by eating a healthy diet.
Download ATS Patient Information leaflet /Part 1
Download ATS Patient Information leaflet /Part 2