Introduction

Bronchiectasis is a lung problem where your airways (tubes that go into your lungs) become damaged and expand. Damaged airways can't clear mucus properly. Bacteria then grow in the mucus, which has an impact on your lungs by causing more swelling and harm. This makes you cough a lot as your body tries to eliminate the infected mucus.

What are the Types of Bronchiectasis?

Doctors categorise bronchiectasis into types based on how your airways look when damaged — cylindrical (or tubular), varicose or cystic. The most common and least serious type is cylindrical bronchiectasis. Cystic bronchiectasis stands as the most severe form. Doctors also sort bronchiectasis as focal (in one spot) or diffuse (in many spots across your lungs). Traction bronchiectasis occurs when lung scarring pulls your airways out of their normal shape.

What are the Symptoms of Bronchiectasis?

Bronchiectasis symptoms include:

• Cough that brings up thick mucus and pus
• Frequent colds
• Mucus with a foul odour
• Trouble breathing
• Whistling sound when breathing
• Coughing blood
• Swollen fingertips and curved nails
• You might have periods when your symptoms improve followed by times when they worsen (flare-ups). During flare-ups, you may experience:
• Extreme tiredness
• Fever and chills
• More difficulty breathing
• Sweating at night

What Leads to Bronchiectasis?

Bronchiectasis happens because of two stages of airway harm.

• Initial damage:This first stage involves the initial damage (or "insult") that an infection, inflammatory disorder, or other lung-affecting condition causes. Doctors can't pinpoint the initial cause in many people who have bronchiectasis.
• Vicious cycle: The first damage makes your lungs more prone to inflammation and repeated infections that lead to further damage.

Some specific causes of the initial damage ("insult") that start the bronchiectasis cycle include:

• Cystic fibrosis Mycobacterial infections such as MAC infections or tuberculosis (TB).

• Autoimmune or inflammatory disorders, including rheumatoid arthritis (RA), inflammatory bowel disease (IBD), lupus (SLE) & Sjögren's syndrome.

• Foreign bodies, tumours or lymph nodes that block airways and prevent mucus from clearing.

• Conditions that lower immunity and make infections more likely (like HIV and hypogammaglobulinemia).

• Primary ciliary dyskinesia

• Organ transplant. Transplant medications lower immunity and can make infections and bronchiectasis more likely.

• ABPA (Allergic bronchopulmonary aspergillosis)

• Scarring from radiation also known as fibrosis.

• A deficiency in alpha-1 antitrypsin.

Diagnosis

Medical history: Your doctor will diagnose bronchiectasis by listening to your lungs.If they suspect you have bronchiectasis or another lung problem, they will order imaging tests to examine your lungs' structure. Diagnostic tests: Chest CT scan or X-ray: Helps check for damage to your airways. Blood tests and sputum cultures: Your doctor collects samples of your blood or mucus (sputum) to check for infections. Lung function tests: Your doctor runs these tests to see how well your lungs work. You will need to breathe into a device that measures your lung function. Genetic testing: Your doctor might take samples of your blood or other body fluids to test for diseases. Bronchoscopy: Sometimes, a doctor will use a bronchoscope (a long bendy tube with a light and camera on the end) to find and take out anything blocking your airways and get samples of mucus or pus from your lungs to test.

Treatment

• Bronchiectasis has no complete cure, but you can manage its symptoms. Doctors treat bronchiectasis by removing mucus and controlling infections. Your doctor might prescribe drugs or physical therapy depending on how severe your condition is. You might also use devices to help clear mucus.
• Treating the underlying cause of bronchiectasis improve your symptoms. In rare cases, if you have a small area of bronchiectasis, your doctor might suggest surgery.
• Treatments for bronchiectasis aim to remove infected mucus, kill germs, and reduce swelling. These include:

Antibiotics: Antibiotics cure infections that bacteria cause. You might use a nebuliser for inhaled drugs and antibiotics which turns the medicine into a mist you can breathe in. Macrolides: Macrolides are drugs that fight infections and reduce swelling at the same time. Expectorant and mucolytics: These drugs make mucus thinner and help you cough it out. You can buy these over-the-counter or get them with a prescription. Physical therapy: Postural draining & chest percussion therapy help loosen and remove mucus. Breathing exercises open up your airways. Medical devices: Oscillating positive expiratory pressure (PEP) devices and percussive vests break up and pull mucus out from your lungs.