Common Conditions


What is bronchiectasis

Bronchiectasis is the condition when the airways in the lung are larger that seen in the normal person. The airways are usually described as dilated and can be seen on the x-ray or CT scan to extend much further into the lung than is normal.

Do I have bronchiectasis?

Bronchiectasis is one of the causes of chronic cough. The most common presentation is that of coughing with copious amounts of mucopurulent phlegm production on a daily basis. Besides this, patients may occasionally cough out blood. Another common occurrence is that of frequent chest infections and visits to the doctor that require antibiotics.

How did I get bronchiectasis?

Bronchiectasis is scarring of the lung that usually occurs after a bacterial infection. The sequelae of the infection usually involves scarring of the lungs that will lead to dilatation of the airways ( bronchiectasis). Some people may recall a childhood infection that may have been severe enough to have been hospitalised while some others may have no recollection at all. People who have had tuberculosis in the distant past that has resulted in lung damage or scarring can also have bronchiectasis.

Other conditions such as measles in childhood, influenza and non-tuberculous mycobacteria may cause bronchiectasis. Obstruction of the airway by foreign bodies, inborn abnormalities of the airway as well as abnormal swallowing mechanisms can all predispose towards bronchiectasis.

Some rare conditions may predispose to bronchiectasis because they make the sufferer more prone to bacterial infections. These include inborn deficiencies in the immune system such as hypogammaglobulinemias and cystic fibrosis.

Can it be cured? If not, what can I expect in the future?

Image of CXR

Chest x-ray of a patient with severe pneumonia

Once the lung is scarred up, it cannot revert to its original architecture. Bronchiectasis is a permanent condition and cannot be cured per se. The result is a part of the lung that has abnormal pooling of airway secretions and this results in increases phlegm production. Some patients complain of coughing out phlegm as they change the position of the body ( ie on lying down or turning) because the pooled phlegm drains in certain postures.

Another sequelae is recurrent infections. this usually is signalled by an increase in the phlegm over the usual amounts as well as a change in colour or smell from the usual pattern. These infections need to be treated with appropriate antibiotics to prevent a more serious outcome.

A feared outcome from bronchiectasis is colonization with Pseudomonas aeruginosa. This organism is fastidious and predisposes to recurrent pneumonia which can hospitalize a patient.

What can I do to prevent problems from bronchiectasis?

Patients with a history of bronchiectasis should be seen by a chest specialist. The condition is chronic and episodic worsening of the condition by bacterial infections are prone to occur. Your specialist may refer you to a physiotherapist who will teach you how to clear the affected parts of the lung of phlegm and this may reduce the incidence of infections. Some patients may benefit from long term antibiotics. Surveillance to assess for infections by opportunistic organisms is also part of the management of this condition.

What if I cough out blood?

Bronchiectasis patients are prone to cough out blood. This is because of the increased blood flow in the affected areas that may lead to formation of new blood vessels which are more fragile. The bleeds often occur during an infective episode.

You should always see your doctor in the event of a new episode of bleeding. This may sometimes be due to an unrelated event such as lung cancer or TB. Often, it is due to a bacterial infection that is amenable to treatment with antibiotics.

If the amount of blood is small ( blood streaked sputum ) and you do not have any other symptoms such as breathlessness, chest discomfort etc., you may wait till the next day to see your doctor. However, in cases when the bleeding produces fresh blood in larger amounts or if you are breathless even if the amount is small, you should immediately go to the nearest hospital.

[Article Ref: Singapore Respiratory Specialists (SRS)]i