What is bronchiectasis?

Bronchiectasis is a pathological, bag-like expansion of the bronchi. It is caused by frequent infections in the lungs and is irreversible. A typical symptom of bronchiectasis is severe coughing with mucous sputum.

Causes of bronchiectasis

The causes may be congenital or acquired. Bronchiectasis is caused by damage to the bronchial walls of the bronchi in the lungs, which leads to a permanent enlargement of the bronchi. This is caused by a disturbance to the self-cleaning mechanism of the bronchi. Pathogens and foreign bodies entering the lungs from the outside are normally carried outside again by the ciliary hairs lining the bronchi. If the cilia are damaged and the bronchial mucus is unable to drain well, the pathogens remain in the lungs causing recurrent infections that lead to long-term bronchiectasis.

Symptoms of bronchiectasis

The typical symptom of bronchiectasis is severe coughing. The result is too much slimy sputum, which smells unpleasant and often contains blood or pus.
At the same time, the underlying infection may result in a fever, respiratory distress and often also pneumonia.

Causes of bronchiectasis

The causes of bronchiectasis may be congenital or acquired.

The congenital causes of bronchiectasis include:

  • Mucoviscidosis (cystic fibrosis), an hereditary disease that causes, among other things, the formation of mucus in the bronchi and trachea.
  • Immunodeficiencies leading to insufficient defence against pathogens, which results in more respiratory tract infections.
  • Rare genetic disorders of the lung self-cleaning mechanism, primary ciliary dyskinesia (PCD).
  • Congenital malformation of the alveoli leading to secretion congestion.

Acquired causes of bronchiectasis:

  • Repeated infection of the bronchial system (especially in childhood).
  • Pneumonia, measles and whooping cough also can damage the bronchi.
  • Bronchus stenosis: constriction of the bronchi due to foreign bodies or tumours. Bronchial secretions cannot drain well, resulting in inflammation.
  • Scars in the bronchial system that prevent the draining of secretions after pneumonia or tuberculosis.

Bronchiectasis: Investigations and diagnosis

Diagnosis of bronchiectasis involves several investigations carried out together. The doctor listens to the lungs with the stethoscope, because bronchiectasis can cause typical rattling noises and a humming noise when breathing.

Diagnosis is supported by means of x-rays or computed tomography. The causes of bronchiectasis can be determined by means of blood tests and molecular biological examinations. These procedures are able to detect any defects in the immune system.
A number of other procedures, such as pulmonary function testing, sputum analysis or bronchoscopy also may be used to determine the exact causes of dilated bronchi.

Bronchiectasis: Therapy

Bronchiectasis therapy relies on two key elements: secretion mobilisation and the treatment of infections with antibiotics. It is also important to recognise and treat the underlying illness.

Secretion mobilisation for bronchiectasis therapy takes place in several steps, which those affected must learn.

  • Inhalation of expectorants
  • Tapping massages to loosen the mucus
  • Expectoration in a specific body position

Additional bronchodilating drugs may be used. Very rarely, bronchiectasis is removed surgically.