Bronchiectasis

Overview

Bronchiectasis is a chronic lung condition characterized by the permanent and abnormal widening of the bronchial tubes, which are the airways that carry air in and out of the lungs. This widening damages the normal structure and function of the airway walls, particularly the tiny hair-like structures called cilia that help clear mucus. As a result, mucus accumulates and becomes difficult to expel, creating an environment where bacteria can thrive. This leads to repeated lung infections, which further damage the airways and perpetuate a cycle of inflammation, infection, and respiratory decline.

Disease Mechanism

In healthy lungs, the bronchial tubes are lined with cilia that move in a coordinated manner to clear out mucus and foreign particles. When the airways are exposed to repeated infections or long-term irritation, these cilia can become damaged or lost, and the bronchial walls begin to lose their elasticity. The airways become dilated, rigid, and scarred, which makes it much harder to clear secretions effectively. As mucus accumulates, it creates a breeding ground for bacteria, triggering more infections that worsen the inflammation and cause further destruction to the airway structure.

Causes and Contributing Factors

Bronchiectasis can be caused by a variety of conditions, both acquired and inherited. One of the most common causes is repeated or severe lung infections, such as pneumonia or tuberculosis, particularly if they occurred during childhood. Genetic conditions like cystic fibrosis are also major contributors; in these cases, thick, sticky mucus builds up in the airways, leading to frequent infections and airway obstruction.

Other contributing factors include immune system deficiencies that reduce the body’s ability to fight infections, airway blockages caused by tumors or inhaled foreign bodies, and chronic exposure to toxic gases or chemical fumes. In rare cases, congenital syndromes like Kartagener’s syndrome — which affects cilia movement — can result in early-onset bronchiectasis.

Symptoms

The most prominent symptom of bronchiectasis is a persistent, productive cough that produces large amounts of thick or purulent sputum, particularly in the mornings or after lying down. This cough tends to be chronic and may continue for months or years. As the condition progresses, patients often experience shortness of breath, especially during exertion, and may develop wheezing or crackling sounds during breathing, due to airflow obstruction and mucus retention.

Many patients suffer from frequent chest infections or bronchitis that require repeated courses of antibiotics. In more severe cases, blood in the sputum (hemoptysis) may occur due to inflammation and fragility of the airway walls. Over time, chronic inflammation and low oxygen levels can lead to weight loss, fatigue, and clubbing of the fingers, which is a physical change in the shape of the fingertips associated with chronic respiratory illness.

Diagnosis

Diagnosing bronchiectasis involves clinical examination along with imaging and laboratory tests. The most reliable tool is high-resolution computed tomography (HRCT), which provides detailed images of the bronchial tree and clearly shows the dilated, distorted airways characteristic of the disease.

Pulmonary function tests are performed to assess the degree of airway obstruction and determine the extent of lung impairment. Sputum cultures help identify the bacteria responsible for infections, which is essential for selecting the right antibiotics. In some cases, blood tests are used to detect immune system deficiencies or genetic conditions like cystic fibrosis.

Treatment

The treatment of bronchiectasis aims to control inflammation, improve mucus clearance, and preserve lung function. It progresses based on the severity of symptoms and the patient’s response, starting with medical therapy, then moving to interventional procedures, and finally surgery if needed.

The first stage is medical treatment: This includes bronchodilators to ease airflow, expectorants to reduce mucus obstruction, and antibiotics in case of recurrent infections. In addition, respiratory physiotherapy is used to clear accumulated secretions. This treatment approach is suitable for mild or stable cases and is typically maintained long-term with regular follow-up.
The second stage is interventional: If the patient shows insufficient response to medications, or if there are clear obstructions in the airways or persistent difficulty in clearing mucus, the abrasive balloon procedure becomes an effective option. This is an advanced bronchoscopic technique performed using precise instruments to clean the airways from within, dilate narrowed areas, remove fibrous build-up and thick mucus, and help restore normal airflow in the lungs. This procedure is considered a breakthrough for managing advanced bronchiectasis, as it directly reduces symptoms, decreases the reliance on antibiotics, and improves the patient’s daily breathing capacity. It shows notable results, especially when sessions are repeated as part of a structured treatment plan.
The final stage is surgical: When the bronchiectasis is localized in a specific lung lobe and causes frequent infections or chronic bleeding despite medications and interventional techniques, surgery may be considered to remove the affected part of the lung. This option is reserved for rare cases that do not respond to any other treatment method and is decided only after a thorough assessment of lung function and disease distribution.

Lifestyle and Follow-Up

Successful long-term management of bronchiectasis requires active patient participation and close medical follow-up. Patients are strongly advised to stop smoking, avoid exposure to air pollution and respiratory irritants, and maintain good hydration to keep mucus thin and easier to clear.

Regular chest physiotherapy sessions and adherence to prescribed medications are essential to stabilize the condition. Moderate physical activity tailored to the patient’s ability can help maintain lung capacity and general well-being. Ongoing communication with a pulmonologist is crucial to monitor disease progression and adapt the treatment plan as needed.

With proper education, consistent care, and lifestyle adjustments, many patients with bronchiectasis can achieve a reasonable quality of life and reduce the frequency of respiratory exacerbations.