Bronchiectasis
In this condition the airways are permanently widened and deformed: instead of springy tubes that push mucus outwards on their own, they become wide sacs with…
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Medicines commonly prescribed for Bronchiectasis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: acetylcysteineManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: PULMONARY INHALATION, 0.2400 gActive substance: salbutamolManufacturer: Laboratorio Aldo Union S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 60 mlActive substance: doxycyclineManufacturer: Hospira Invicta S.A.Prescription required
In this condition the airways are permanently widened and deformed: instead of springy tubes that push mucus outwards on their own, they become wide sacs with slack walls where mucus pools. Bacteria settle there readily, inflammation smoulders on, the bronchial wall is damaged further still, and the circle closes. The airways cannot be restored to their old shape, but the circle can certainly be broken, and almost everything depends on how carefully a person does that day after day.
How it shows itself
The main complaint is a cough that does not go away for months and almost always brings up phlegm. There can be a lot of it, up to a cupful a day, and characteristically the most comes up in the morning and when changing position.
- thick sputum, anywhere from clear and white to yellow and green; during a flare-up there is more of it and it darkens;
- flare-ups recur: several times a year the person feels worse for days or weeks at a time;
- breathlessness on exertion that used to be easy;
- wheezing and whistling in the chest, sometimes audible without a stethoscope;
- streaks of blood in the sputum, which is not unusual in this condition;
- a dull ache in the chest, constant tiredness, sometimes weight loss;
- after many years the fingers change: the end joints thicken and the nails become curved.
The clue is not the cough itself but its persistence: everyone coughs after a cold and it clears within a couple of weeks. A cough lasting more than eight weeks, especially a productive one, always needs an explanation — the earlier the diagnosis, the fewer airways get destroyed along the way.
When you cannot wait
Call the emergency services straight away if:
- you are coughing up a large amount of blood — mouthfuls, clots, bright red rather than streaks;
- breathing suddenly becomes very hard: you are short of air at rest and cannot finish a sentence;
- your lips or fingers turn blue;
- confusion or heavy drowsiness develops alongside the breathlessness.
Bleeding from the lung is the most dangerous complication of this condition, because the walls of the widened airways are wrapped in fragile, overgrown blood vessels. It is uncommon but builds quickly, and it is stopped in hospital rather than at home. Until help arrives it is better to sit up than to lie down.
Why the airways widened
A cause is found in roughly two thirds of people, and looking for it is not a formality: some causes are treated separately, and without that the disease keeps progressing however well the airways are cleared.
- a severe past lung infection — pneumonia, tuberculosis, whooping cough, measles; sometimes it happened in childhood, decades before the first symptoms;
- cystic fibrosis — an inherited condition in which mucus throughout the body is thick; milder forms are picked up in adulthood too;
- primary ciliary dyskinesia — a congenital defect of the tiny hairs that sweep mucus out of the airways; nasal blockage and ear infections since childhood point towards it;
- immune problems, including a shortage of protective blood proteins — found with a simple blood test and treatable by replacement;
- an allergic reaction to a mould fungus inside the airways — it occurs in severe asthma and is treated quite differently from an ordinary flare-up;
- non-tuberculous mycobacteria — a slow-burning infection requiring a long, specific drug regimen;
- chronic obstructive pulmonary disease and severe asthma;
- rheumatoid arthritis, inflammatory bowel disease and other systemic conditions;
- inhaling corrosive substances or smoke, and stomach contents passing into the airways;
- a foreign body or a tumour blocking a bronchus — in that case the widening is confined to one area.
If no clear cause turns up, that is not a dead end: follow-up over the years sometimes uncovers one after all, and in the meantime the treatment is the same.
How the diagnosis is made
An ordinary chest X-ray often looks almost normal in this condition, so it neither confirms nor rules out the diagnosis. The decisive test is a high-resolution CT scan: on it the airway is visibly wider than the artery running beside it, and the airways can be traced almost to the surface of the lung.
Alongside it, the usual tests are:
- a sputum culture, to know which bacteria live in your airways specifically — that guides the choice of antibiotic during a flare-up;
- a breathing test on a machine, to measure airflow and follow it over time;
- blood tests for immune function and for signs of fungal allergy;
- a sweat test and genetic testing where cystic fibrosis is suspected;
- sometimes bronchoscopy, if only one area is affected and the reason needs to be established.
Follow-up here is ongoing rather than one-off: usually a review at least once a year with checks on lung function and sputum culture.
Clearing the airways: the daily work you do yourself
This is the foundation of treatment, and in terms of how you feel it counts for more than any drug: every day you have to do by hand what the damaged airways can no longer manage.
A respiratory physiotherapist teaches the technique, and it is worth learning it with them rather than from a description: there are several manoeuvres and they are chosen according to where your airways are widened. They involve breathing cycles with forced exhalation, body positions that place the affected area uppermost, and small devices that create vibration and resistance as you breathe out.
- it needs doing every day, usually twice a day for ten to twenty minutes, and more often during a flare-up;
- if the sputum is too thick, the doctor may prescribe an inhaled saline solution before the session;
- walking, swimming and any aerobic exercise work as an add-on and help bring the phlegm up;
- where breathlessness is marked, pulmonary rehabilitation is offered — a supervised exercise programme whose benefit is comparable to that of medication.
On good days it is tempting to skip the exercises, but it is consistency that cuts the number of flare-ups: missed weeks show up afterwards in the amount of sputum.
Medicines and flare-ups
A flare-up is recognised not by fever, which is often absent, but by the sputum: there is noticeably more of it, it has thickened, changed colour and smell, and the cough, breathlessness and fatigue have all increased. It usually builds over a few days.
What is used:
- antibiotics during a flare-up, in courses longer than for ordinary bronchitis; the choice rests on your previous sputum culture;
- a rescue supply of antibiotics kept at home for those with frequent flare-ups, with written instructions on when to start and a duty to tell the doctor once you have;
- long-term preventive treatment where there are three or more flare-ups a year; it requires monitoring, including of heart rhythm and hearing;
- inhalers that open the airways where there is tightness and wheeze, often used before a clearance session;
- inhaled antibiotics where a difficult bacterium is grown persistently;
- oxygen and, in rare severe cases, surgery on a limited area or a lung transplant.
Mucus-thinning tablets have shown no particular benefit here, and they are no substitute for daily airway clearance. Cough suppressants, on the other hand, are actively unwanted: here the cough is the way mucus gets out, and silencing it is dangerous.
What cuts down the flare-ups
- stopping smoking altogether and staying out of smoky rooms — the single most effective step;
- the yearly flu vaccine, the pneumococcal vaccine and others as advised by your doctor;
- washing hands and sensible caution during the cold season;
- drinking enough: thick sputum comes up less easily;
- enough protein in the diet and holding your weight — losing it worsens the outlook in this condition;
- treating what comes with it: sinusitis, reflux, asthma, low immunity.
The course of the disease differs greatly from person to person: in some it stays mild for years and barely interferes with life, in others it gradually reduces what they can do. Two things decide the outcome — a cause found and treated, and discipline in clearing the airways every day.
Online consultation
In an online consultation the doctor goes through the long-standing cough and the nature of the sputum, explains when a CT scan is needed and why a plain X-ray is not enough here, helps you make sense of reports and culture results you already have, reviews whether every cause has been excluded, and works out with you a plan for what to do during a flare-up.
This material is for information only and does not replace medical advice.
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