Bronchiectasis

What are bronchiectasis

Bronchiectasis are protrusions of the bronchial tubes in the lungs. The word “bronchiectasis” is derived from the Greek word éktasis, which means dilation.

Increased thick bronchial mucus accumulates in the bulges, which is difficult or impossible to cough up. The mucus in the bronchial tubes in turn provides an ideal breeding ground for bacteria and other pathogens to colonize and multiply. Lung infections are therefore not uncommon.

Bronchiectasis can be congenital (much rarer) or acquired (most common). The main causes are infections and chronic lung diseases associated with inflammation in the airways. Bronchiectasis is congenital, for example, if the unborn child’s lungs do not develop properly in the womb. The lung disease cystic fibrosis, which is present from birth, and alpha-1-antitrypsin deficiency also significantly impair lung function and can lead to bronchiectasis.

Bronchiectasis cause symptoms such as severe coughing with sputum, shortness of breath, fatigue, weight loss and frequent infections. The bulging of the bronchial tubes cannot be reversed – they are not reversible, as experts say. Accordingly, the lung disease cannot be cured. Nevertheless, bronchiectasis can be treated with medication, for example, which alleviates the symptoms and prevents or slows down the progression of the disease. Physiotherapy with targeted breathing exercises also helps many patients and is considered an essential part of therapy. If the protrusions only affect part of the lung, surgery is also possible. At a very advanced stage, a lung transplant is the last treatment option.

The prognosis always depends on how well the treatment works and whether complications develop, such as right heart failure.

International data show that acquired bronchiectasis has increased in recent years, and the trend is rising. There are no exact figures on the frequency. Doctors estimate that around 50 out of 100,000 people acquire bronchiectasis in the course of their lives.

Bronchiectasis: Causes and risk factors

The exact mechanisms of bronchiectasis are not yet fully understood. However, doctors know that bronchiectasis is associated with inflammation in the airways:

• These damage the walls of the bronchial tubes and the connective tissue of the lungs.
• As a result, the fine cilia are no longer able to remove mucus and foreign substances from the bronchial tubes and thus cleanse the lungs.
• Because this self-cleaning mechanism of the lungs (also known as mucociliary clearance) is disturbed, thick bronchial mucus builds up in the cavities.
• This in turn provides ideal living conditions for bacteria, viruses and fungi to colonize and multiply. Constantly recurring infections are the result.

Bronchiectasis can affect one or both lungs. They can be localized or extend to several areas of the lung. They can also take on different shapes, such as cylindrical or sac-shaped (in which case they resemble cysts).

Acquired bronchiectasis – causes

Acquired bronchiectasis occurs most frequently. The causes are usually infections and chronic lung diseases. These include, for example:

• Repeated respiratory tract infections, especially in childhood: The structure of the bronchial tubes changes due to the constant inflammation and the bronchial tubes become congested.
• Measles
• Pneumonia (lung inflammation )
• Tuberculosis
• Whooping cough (pertussis)
• Chronic bronchitis
• Bronchial asthma
• Advanced chronic obstructive pulmonary disease(COPD). As the number of COPD patients is increasing, bronchiectasis is also becoming more important.

Today, however, effective vaccinations and antibiotics are available, which is why diseases such as tuberculosis, measles and whooping cough are less common causes of bronchiectasis.

Other causes that can irritate and inflame the airways are constricted or blocked bronchial tubes. These can be caused by foreign bodies or tumors, for example. Inhaling toxic substances such as tobacco smoke, gases or toxic liquids can also damage the lungs.

Causes of congenital bronchiectasis

Congenital bronchiectasis is much rarer. They can form if the embryo’s lungs do not develop properly in the womb. The large, sac-shaped cavities are filled with bronchial secretions and cannot later contribute to the vital gas exchange in the lungs. There are also certain congenital diseases that are possible causes of bronchiectasis. Examples are:

• Cystic fibrosis (CF): The secretions in the bronchi are viscous and accumulate in the bronchi. In Europe, bronchiectasis is often found in people with cystic fibrosis.
• Primary ciliary dyskinesia (PCD, Kartagener syndrome) – a rare, congenital disease of the airways in which the movement of the cilia is disturbed.
• Alpha-1-antitrypsin deficiency: a hereditary disease in which the enzyme alpha-1-antitrypsin is absent or present in insufficient quantities. Tissue damage to the lungs and liver can be the result.

These diseases mean that bronchial secretions cannot be cleared properly and accumulate in the lungs. This causes irritation and inflammation, which can lead to bronchiectasis in the long term.

Sometimes no specific causes can be found for the bulging of the bronchial tubes. “Idiopathic” – i.e. without a recognizable cause – is the technical term for this.

Symptoms: Bronchiectasis cause severe coughing

Bronchiectasis are associated with various symptoms. These include:

• Prolonged, violent cough with sputum: The amount of sputum may vary as well as its color (white, yellow, green or brown). It can also be mixed with pus and blood and smell unpleasant.
• Shortness of breath and shortness of breath: During physical exertion and in severe cases also during less strenuous activities. The reason for this is that the damaged airways no longer function well.
• Tiredness, fatigue, exhaustion: fighting the infection and coughing are energy-sapping for the body.
• Pain or tightness in the chest.
• Fever in episodes when the bronchial tubes are congested.
• Lack of physical fitness
• Weight loss
• Coughing up blood in the event of pulmonary hemorrhage, which can be particularly dangerous in large quantities.

Bronchiectasis: Diagnosis

The diagnosis of bronchiectasis always begins with an anamnesis; a conversation about your medical history. For example, we are interested in the following questions:

• What symptoms do you have and how long have you had them? (for example, cough with or without sputum, color of sputum, shortness of breath)
• How pronounced are your complaints?
• Are there situations in which the symptoms occur more frequently? (for example, coughing in the morning or shortness of breath during physical exertion)
• Do you have any known diseases? If yes: Which ones?
• Are there any known illnesses in your family? If yes: Which ones?
• Are you taking any medications? If yes: Which ones and since when?

Your answers provide us with initial clues as to the cause of your symptoms. It is important to rule out other diseases such as bronchial asthma or chronic obstructive pulmonary disease (COPD), which are associated with similar symptoms. As a rule, the consultation is followed by a physical examination. For example, we listen to the lungs with a stethoscope and listen to the sounds made when breathing in and out. Rattling or whistling noises can often be heard in bronchiectasis.

Further examinations to draw conclusions about the condition of the lungs:

• Computed tomography (CT): An X-ray examination in which radiology specialists take images of the body “slice by slice” and produce detailed cross-sectional images of the lungs.
• Lung function test: For example, spirometry is used, in which you breathe forcefully and quickly into a device. It cannot be used to diagnose bronchiectasis, but it does show how well your lungs are intact.
• Sputum analysis: The sputum is examined in the laboratory for bacteria and other germs. At the same time, laboratory doctors can determine the type of bacteria, which is important for subsequent treatment with antibiotics.
• Lung endoscopy (bronchoscopy): Examination of the airways using a bronchoscope.
• X-ray examination of the chest (chest X-ray) – bronchiectasis cannot usually be detected on the X-ray, but it helps to rule out other diseases.
• Blood test: The blood values provide general information about your state of health. This enables us to track down the possible causes of bronchiectasis.

Bronchiectasis: Prevention, early detection, prognosis

There are no special measures you can take to prevent bronchiectasis. The same applies to early detection. As with many other diseases, a healthy lifestyle is important to strengthen the immune system:

• healthy nutrition
• A lot of movement
• do not smoke
• drink no or moderate alcohol
• Reduce and avoid stress

Bronchiectasis can have various consequences. You can protect yourself against some of them with a vaccination and thus prevent complications. Vaccinations against influenza and pneumococci, for example, are advisable. You can find out who should be vaccinated, how often and when in the Swiss vaccination schedule.

Course and prognosis of bronchiectasis

The course and prognosis of bronchiectasis cannot be generally predicted. The course of the disease varies from person to person and can be mild, moderate or severe. Your age, other concomitant illnesses and your general state of health also play a role in the course and prognosis. Some patients experience only mild symptoms and can lead a normal everyday life. For others, however, normal life is impaired and their quality of life and enjoyment of life suffer considerably.

The prognosis also depends on how well the treatment works and whether complications occur. The symptoms can worsen and complications can occur. Some examples:

• Recurrent respiratory infections – the infections are often followed by even more bronchiectasis and the lung function continues to decline.
• Chronic obstructive pulmonary disease (COPD) – a chronic respiratory disease that can also rarely occur in non-smokers.
• Right heart failure (right heart failure): The function of the right heart is impaired.
• Lung abscess: Cavities filled with pus form in the lung tissue.
• Pulmonary hemorrhage: coughing fits with blood sputum
• Pleural empyema: accumulation of pus in the pleura (pleura)

Timely and adequate treatment is therefore very important to prevent such complications from arising in the first place.

Bronchiectasis: Treatment with multiple strategies

The treatment of bronchiectasis aims to alleviate the symptoms, slow down the progression of the disease, prevent complications and improve the quality of life. As a rule, several therapies are used in combination. The therapy can often keep the lung disease stable for many years and the symptoms under control.

Bronchiectasis: Use of surgery

In rare cases, the disease cannot be controlled despite correct medical and physiotherapeutic treatment. If the bronchiectasis is limited to a circumscribed anatomical area (lung lobe), surgical intervention may be a treatment option. This involves removing the part of the lung that has been destroyed by the chronic inflammation. Surgical removal may also be necessary in the event of complications (superinfection with resistant germs or bleeding).