Bronchiectasis explained

What happens in the lungs

In healthy lungs, the airways are lined with tiny hairs and a thin layer of mucus that trap dust and germs and sweep them up and out. In bronchiectasis, repeated damage causes some airways to become permanently widened, floppy and scarred. These damaged airways cannot clear mucus properly, so it pools and stagnates. Bacteria thrive in this trapped mucus, causing infection and inflammation, which damages the airways further. This sets up a vicious cycle: damage leads to infection, and infection leads to more damage. The result is a chronic cough that brings up phlegm, and a tendency to get chest infections again and again. Understanding this cycle explains why clearing mucus is at the heart of treatment.

What causes it

Bronchiectasis has many possible causes, though in a good number of people no clear cause is ever found. A common trigger is a serious lung infection in the past, such as severe pneumonia, whooping cough or tuberculosis, which damaged the airways. It can also result from problems with the immune system that make infections more likely, from conditions where mucus is abnormally thick such as cystic fibrosis, and from inhaling foreign material or stomach contents into the lungs. Some people have underlying conditions affecting the airways or the tiny hairs that clear them. Because the cause affects management, doctors usually run tests to look for a treatable reason, even though many cases remain unexplained after investigation.

Symptoms and diagnosis

The hallmark symptom is a long-standing cough that brings up phlegm, often daily, which may be discoloured. People may also have breathlessness, wheezing, chest discomfort, tiredness, and recurring chest infections that take a while to clear. During flare-ups, the phlegm increases and changes colour, and breathlessness worsens. Some people cough up small amounts of blood. Diagnosis usually involves a detailed history and a special type of scan called a high-resolution CT scan of the chest, which shows the widened airways clearly. Doctors also test phlegm samples to identify bacteria, check lung function with breathing tests, and look for underlying causes with blood tests. Getting a firm diagnosis helps tailor treatment and set realistic expectations.

How it is managed

There is no cure, but bronchiectasis can be well controlled, and the cornerstone is airway clearance — techniques that help move mucus out of the lungs every day. A physiotherapist teaches breathing exercises and positions, and sometimes devices, to make coughing up phlegm easier and more effective; doing this regularly reduces infections. Staying active and doing pulmonary rehabilitation exercise programmes also help. Chest infections and flare-ups are treated promptly with antibiotics, and some people with frequent flare-ups may be given longer-term preventive treatment under specialist care. Vaccinations, such as the flu and pneumococcal jabs, are recommended to reduce infections, and treating any underlying cause is important. Not smoking and keeping generally fit support the lungs too.

Living well and spotting flare-ups

Most people with bronchiectasis lead full lives by building good daily habits and knowing their own pattern. Doing airway clearance regularly, staying active, keeping vaccinations up to date and drinking enough fluids all help. It is important to recognise a flare-up early: signs include more phlegm than usual, phlegm changing colour, worsening breathlessness or cough, feeling more tired or unwell, and sometimes a fever. Acting quickly, often with a course of antibiotics from your care plan or GP, can stop a flare-up worsening. You should seek urgent medical help if you become very breathless, cough up a larger amount of blood, or feel seriously unwell. Regular reviews with a GP or lung specialist help keep the condition stable over time.