Bronchiectasis: Symptoms, treatment and outlook

Bronchiectasis is a condition that affects the airways of the lungs. The airways become widened and thickened, which means that they produce and secrete more mucus than normal. This enables germs to live and breed within the lungs, and it can become difficult for patients to clear the secretions. Patients with bronchiectasis are very likely to have recurrent chest infections.

We were fortunate to ask renowned respiratory medicine consultant, Dr James Ramsay, all about the condition, including how it might compare to symptoms of lung cancer, other possible conditions that may be linked to bronchiectasis, and what the outlook may be.

How can you tell the difference between bronchiectasis and lung cancer?

A lot of the symptoms that patients with lung cancer develop are similar to bronchiectasis. The main symptoms of both conditions include chronic cough, recurrent chest infection, shortness of breath, chest pain and coughing up blood.

As the symptoms can be similar, it can be difficult to distinguish between the two. However, there are some features with lung cancer that we call red flags. These include symptoms of:
 

• Persistent cough for more than three weeks
• Shortness of breath
• Repeated chest infections
• Chest and/or shoulder pain 
• Loss of appetite and fall in weight
• Coughing up blood
• Finger clubbing (formation of curvature of the nails)
• Blood clots in the leg or the lung

This list of red flag symptoms for lung cancer is very similar to some symptoms of bronchiectasis.

Your doctor will be really careful when taking your history and they will incorporate the physical findings of an examination. They will proceed with a chest X-ray and CT scan to have a better understanding.
 

How is bronchiectasis managed?

Bronchiectasis can be managed by your doctor using any of the following:
 

• Immunisation – flu or pneumonia vaccine and childhood immunisation for whooping cough and measles.
• Chest physiotherapy - respiratory physiotherapy can teach you a number of breathing exercises. If you do this regularly, it helps to clear secretions and prevent infections.
• Medications – can be prescribed to help minimise future infections. This may include inhaled therapies to open the airways and, in some instances, inhaled steroids. These help to keep the airways open. Drugs called mucolytics may also be used to help clear lung secretions.
• Anti-inflammatory drugs and antibiotics – antibiotics are used to treat infective episodes, they can also prevent future infections. This may include low dose oral antibiotics or nebulized antibiotics, such as a mist inhaler.

Is bronchiectasis hereditary and what other diseases can be linked to the condition?

Bronchiectasis can be either:
 

Congenital

Some people are more susceptible to bronchiectasis if they have inherited conditions such as cystic fibrosis or low immunoglobin levels (chemicals that we produce that fight infection), called hypogammaglobulinemia. A rarer cause of bronchiectasis is primary ciliary dyskinesia, which is often found in younger age groups.
 

Acquired

If the patient has an underlying problem like asthma, chronic obstructive pulmonary disease (COPD) or pulmonary fibrosis, it can predispose them to bronchiectasis. This also occurs in people who have had previous infections like pneumonia or whooping cough. Tuberculosis can cause damage to part of the lung, which can then lead to bronchiectasis. For those who have an immune deficiency, such as HIV, a reduced immunity can predispose them to bronchiectasis.

Long COVID-19 has left patients with many different types of conditions, such as chronic fatigue, organ impairment, shortness of breath, and chest pain. We are seeing some patients with pulmonary fibrosis, which means that there is a potential risk that we might see bronchiectasis in patients who have suffered from COVID-19. However, there is not enough research on coronavirus and bronchiectasis currently, and it is too early to tell whether the conditions could be linked.
 

What’s the life expectancy of someone with bronchiectasis?

In cases of bronchiectasis, our main concern is to prevent future infections. We want to treat any infections promptly so that the patient can maintain lung function over time. The good news is that the condition is absolutely manageable.

If someone with bronchiectasis has a good management plan and adhere to it, it’s a controllable disease. It may impact someone if they are susceptible to chest infections, but in terms of prognosis, if it is well-managed you prevent further deterioration and minimise the likelihood of progression. It shouldn’t have a significant impact on someone’s long-term outlook.



Dr James Ramsay is an expert in treating bronchiectasis. You can make an appointment with him via his Top Doctor’s profile. Can’t make it in person? Dr Ramsay is available for a video call using our e-Consultation tool, which is also found on his profile.