Bronchiectasis

Bronchiectasis is a lung condition that affects the breathing tubes or airways in your lungs. If you have bronchiectasis, the walls of the airways become wider and damaged due to inflammation or infection. You will have more sputum (also called mucus or phlegm). This sputum can be harder to cough out, and if it is not cleared properly it may lead to more infections and damage. Bronchiectasis may be only in one or two areas in the lungs, or it may be in many areas of the lungs

Bronchiectasis can affect people of all ages, including children. It is more common in women and older people.

Māori and Pacific communities have a higher risk of getting bronchiectasis than Pākehā people; the illness can be worse and they may spend more time in hospital.

The most common cause of bronchiectasis is having a bad chest infection from the flu, measles, whooping cough, or other viruses or bacteria.

There are some less common causes of bronchiectasis, such as a weakened immune system from a primary immunodeficiency (from birth) or a secondary immunodeficiency that develops later in life from another health condition, or due to medications that suppress the immune system.

Other causes include breathing in something like a nut or small toy/object, breathing in noxious chemicals, or having acid reflux (heartburn), an allergic reaction to a fungus called Aspergillus, and autoimmune health conditions.

Rare, inherited diseases such as cystic fibrosis or primary ciliary dyskinesia can also cause bronchiectasis.

Symptoms can vary between people. The most common symptom is a long-term ‘wet’ (mucus-producing) cough with sputum. For some people, this might only be a small amount of sputum, and for others, this can be as much as an egg-cupful or more every day. A few people have a dry cough with no sputum to cough up.

Other symptoms may include:

• feeling tired
• being short of breath
• getting recurrent chest infections
• some people may cough up blood in their phlegm
• chest pain or discomfort
• sinus or nasal symptoms
• incontinence(urine leakage) when coughing
• anxiety or depression

The healthcare practitioner will ask about your symptoms, your medical history and will listen to your lungs using a stethoscope. If they think you might have bronchiectasis, they will arrange for you to have some tests and may refer you to a specialist respiratory service.

The main test to diagnose bronchiectasis is a high-resolution CT scan of your chest. Other tests may include:

• Chest X-ray
• Spirometry (breathing) test
• Blood tests
• Sputum tests

Bronchiectasis cannot be cured. It is a chronic illness that needs regular treatment.

Daily (and sometimes more often) sputum clearance techniques help to control your symptoms and cut down the number of chest infections you may have, helping to slow down further damage to your lungs.

Treating bronchiectasis is best done by a team of different health professionals; they will work alongside you and your whānau to work out the best treatment plan for you.

This healthcare team may include your primary care doctor or nurse, specialist doctor, specialist nurse, physiotherapist, kaimahi hauora Māori (Māori health worker) or other clinicians or support workers.

Treatments usually include:

• a personalised action plan (self-management plan) to help you control your symptoms
• breathing exercises (chest physio) to help you clear the sputum from your lungs
• antibiotics for any chest infections
• teaching you ways to help manage breathlessness
• flu and COVID vaccines, and other recommended vaccines
• advice on keeping your home warm and dry
• advice and support to stop smoking and other lifestyle changes
• treatment for other illnesses or problems that may be making your bronchiectasis worse, for example, acid reflux (heartburn) or immune problems