Bronchiectasis

What is bronchiectasis?

Bronchiectasis means the airways in your lungs aren't working properly.

If you have bronchiectasis, some of the airways in your lungs are too wide. This usually happens because the walls of the airways have been damaged. When the airways are too wide, mucus builds up inside them.

When you have a lot of mucus in your lungs, you may find it hard to cough it all out. The mucus that gets left behind can be infected by bacteria. This means you get a chest infection.

Most people who have brochiectasis have a conditon called cystitis fibrosis. Cystic fibrosis is an inherited condition that is usually diagnosed in babies or young children. Adults who get brochiectasis might get it after an infection, such as measles of tuberculosis (TB) or after breathing in a harmful chemical.

What are the symptoms?

The main symptom of bronchiectasis is coughing up a lot of mucus (also called sputum). You might cough up as much as half a litre (one pint) of mucus in a day. You might also feel breathless, cough up blood, wheeze and get tired.

These symptoms can be alarming and make you feel unwell. It can be especially distressing watching this happening to your child. If the symptoms seem worse than usual, you should talk to your doctor.

What treatments work?

Exercises to strengthen your chest muscles can help you or your child breathe more freely and make it easier to live a normal life. To train your chest muscles, you breathe in through a device that makes your muscles work harder. You'll be shown how to use the device by a doctor, nurse or other health professional. You'll probably have to train 30 minutes a day, five days a week.

Many doctors recommend that you or your child has physiotherapy and learn exercises to help you get rid of the mucus in your lungs. But we don't know how well this works. There isn't enough evidence to say

Some people find it helpful to blow out into a small device that helps them to loosen the mucus. Other people learn how to loosen the mucus by tapping their chest, or using gravity to help the mucus drain out of their chest.

Your doctor may also try some medicines tohelp you or your child breathe more easily. But there's not much evidence that they work. The medicines might include:

• A bronchodilator (a drug to open up the airways). There are many different types. Ones that are commonly used include salbutamol (brand names Ventolin, Salamol, Easi-Breathe, Airomir) and terbutaline (brand name Brycanyl). You breathe these in. They can make your hands tremble, especially when you first use them. They may also make you feel as like your heart is beating faster. But this should go away when you reduce the dose. Or you may be given theophylline tablets (brand names Nuelin SA, Slo-Phyllin, Uniphyllin Continus). You can also get syrups and injections. Theophylline can make you feel sick, and cause diarrhoea and headaches.
• Steroids (to make your airways less inflamed). Steroids that you breathe in include beclometasone (brand names Becyotide, Qvar), budesonide (brand name Pulmicort) and fluticasone (brand name Flixotide). Or you might have steroid tablets, such as prednisolone. You might get thrush in your mouth when you use a steroid inhaler. And if you take steroids for a long time your bones might become weaker.
• A mucolytic (a drug to break up mucus). One that you breathe in through a mask is called dornase alfa (brand name Pulmozyme). You might feel as though you have the flu when you take this.
• Salt water or hypotonic saline (to make your mucus thinner). You breathe this in through a mask using a machine called a nebuliser.

If parts of your lung are very badly damaged, your doctor may advise you to have an operation to remove the worst parts. But surgery for bronchiectasis is rare. Your surgeon is more likely to suggest this if you often cough up a lot of blood and find it very hard to breathe properly.

There hasn't been any research about how well surgery works.

What will happen to me or my child?

It's hard to say what will happen. People vary a lot in terms of the symptoms they get. Bronchiectasis doesn't go away. But some people get more symptoms than others.

If you get a chest infection, it may make your symptoms worse for a few days or more. This is sometimes called an exacerbation. Most people get exacerbations once or twice a year. But if you have severe bronchiectasis, you could have six or more a year.

If you get your infections treated quickly, and can cough up mucus, you will probably be able to live with your condition quite normally.

Some people get very bad bronchiectasis. This can be life-threatening in the long term, when you get older. This is because having difficulty breathing can put a strain on the rest of your body, including your heart.

Where to get more help

It can be hard to live with a lung disease like bronchiectasis. If you'd like to be put in touch with people who have the disease, or other parents whose children have it, Breathe Easy might be able to help. It is part of the British Lung Foundation. See http://www.lunguk.org to find out more. Or try the Cystic Fibrosis Trust (http://www.cftrust.org.uk).