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Bronchiectasis

Bronchiectasis

Bronchiectasis describes the widening (“ectasis”) of some of the airways.

The airways normally produce a small amount of mucus (sputum or phlegm) which traps any germs that enter the lungs. This mucus is then carried up to the throat by tiny hairs on the cells lining the airways, known as cilia, to prevent infection.

The widening of the airways occurs in patches due to damage caused by infection. This prevents the effective clearance of mucus, which then increases the chances of further infection and inflammation. The smaller airways are thickened and narrowed due to the inflammation and this leads to breathlessness.

 

  • Symptoms

    If you have bronchiectasis, you are likely to have one or more of the following symptoms:

    • Chronic cough
    • Excessive amounts of sputum which is often yellow
    • Breathlessness
    • Repeated infections in the airways and lungs and therefore common infection symptoms, such as fever or general tiredness

     

  • Causes

    Several conditions can cause bronchiectasis but for some people the cause is unclear.

    People with certain underlying genetic conditions, such as cystic fibrosis or abnormal cilia (e.g. primary ciliary dyskinesia, (PCD)), are likely to develop bronchiectasis due to the nature of the mucus they produce or problems with the function of the cilia in their airways.

    People with problems with the function of their immune system often develop the condition as their immune system is unable to fight off infections.

    Some individuals with COPD, severe asthma or interstitial lung disease also may develop bronchiectasis, which can complicate their condition.

  • Prevention

    Early diagnosis can help control symptoms and delay progression of the condition.  Childhood vaccines against whooping cough and measles may protect against development of bronchiectasis and regular flu vaccines are advised to reduce the chance of complications to the condition from bacterial infection.

  • Treatment

    Bronchiectasis is usually confirmed by a CT scan, which shows the abnormal airways more clearly than a simple chest X-ray. The condition is treated by:

    • Airway clearance techniques (physiotherapy) to assist coughing up the excess mucus from the lungs
    • Reducing airway narrowing with inhaled B2 agonists
    • Regular macrolide treatment (a class of antibiotics with anti-inflammatory effects)
    • Treating exacerbations with antibiotics
  • Burden

    • The number of reported deaths due to bronchiectasis is increasing
    • The cost of care for one episode in hospital is estimated to be €5,900
    • 50% of people with bronchiectasis have an existing condition, such as cystic fibrosis or an immune deficiency, which makes them more likely to develop the condition
    • Bronchiectasis is particularly common in people of Pacific Island descent, compared to European children

     Hospital admission rate for bronchiectasis. Data from the World Health Organization Hospital Morbidity Database, October 2011 update, and Eurostat, March 2012 update. Data are missing for the following countries where bronchiectasis is reported in combination with COPD: Germany, France, Hungary, Ireland, Macedonia, the Netherlands, Romania, Sweden and Turkey.

  • Current and Future Needs

    • Bronchiectasis, other than that due to cystic fibrosis (called ‘non-CF bronchiectasis’) is one of the most neglected respiratory diseases. There is currently no generally agreed classification of the condition, few specialist services and little information on the long term outcome of the disease
    • Significant research is needed to improve both understanding of the condition and the management of those who suffer from the condition