Bronchiectasis: definition, symptoms, causes and live expectancy

In our blog article, we will explain what bronchiectases are, what causes them, and the symptoms and life expectancy of the lung disease.

Bronchiectasis: definition

Bronchiectasis is a pathological expansion and dilation of the bronchial tubes and bronchioles that cannot be healed. The expansions tend to be the shape of a cylinder, sack or spindle. Pulmonologist Prof. Dr Fischer explains bronchiectasis with a comparison: “You can imagine bronchial tubes as tram lines running through the lungs. If the tracks dilate at one point, bronchiectasis develop from these dilations.”

Bronchiectasis is irreversible, which means that they no longer shrink in size, but remain in the airways for the rest of your life. The aim is to ensure that the bronchiectases do not increase in size and that no new ones develop. An individually tailored therapy and treatment of bronchiectasis is therefore essential.

Causes of dilations in the bronchial tubes

Bronchiectasis can be congenital and is common in patients as a consequence of chronic lung diseases, such as cystic fibrosis (CF), primary ciliary dyskinesia (PCD) or COPD. Bronchiectasis is always caused by inflammation in the airways since this damages and destroys the bronchial walls and the elasticity of the connective tissue of the lungs. Pneumologist Dr Fischer says: “Inflammation is generally triggered by bacteria and viruses. It should be noted that according to current medical knowledge, an infection with COVID-19 does not lead to bronchiectasis; so although a COVID-19 infection can cause damage and the consequences long-COVID in the lungs, it does not cause bronchiectasis.”

The destruction of the bronchial walls and connective tissue of the lungs caused by the inflammation destroys the self-cleaning function of the lungs. The mucus in the sections affected by bronchiectasis builds up. The secretion that develops in the lungs is the ideal breeding ground for bacteria and other pathogens, which can cause local infections to fester or new inflammation to develop. “Once mucus starts to collect in the bronchiectasis and bacteria grow there, chronic problems develop. This is because bacterial growth promotes acute inflammation of the lungs, which can then exacerbate infections, which then leads to more and larger bronchiectases. In these cases the symptoms of bronchiectasis are particularly pronounced”, explains Fischer.

Symptoms of bronchiectasis

Symptoms of bronchiectasis are classic symptoms that can occur with other lung diseases too:

  • Cough with mucous sputum
  • Chronic infection and inflammation of the bronchial tubes
  • Purulent expectoration
  • Blood in sputum (haemoptysis)
  • Chest pain
  • Spasm of the airway muscles (bronchospasm)
  • Shortness of breath and respiratory distress (dyspnoea)
  • Reduced resilience to exertion

According to pulmonologist Fischer, a particularly conspicuous sign of bronchiectasis is bringing up large mouthfuls of sputum: “Patients have enormous problems with mucus in the lungs. When they cough, they bring up large amounts of secretion so that their mouth is completely full and they have the feeling that they are overwhelmed by the amount of mucus.”

Bronchiectasis is diagnosed by computer tomography. If bronchiectasis is found, check-ups are required to detect and combat any exacerbations early on. Depending on the extent and activity of bronchiectasis, examination methods include lung function tests, sputum control and reviewing the laboratory values.

Life expectancy with bronchiectasis

The pulmonologist Fischer can give the all-clear: “Evidence of bronchiectases alone does not automatically mean that the patient will go on to develop lung problems”. Nonetheless, bronchiectasis is still a respiratory disorder that you have to take seriously and should treat. There are currently few studies on mortality in bronchiectases not caused by cystic fibrosis. It does seem to be clear, however, that patients with bronchiectases who also have COPD, are most at risk. Mortality also increases with increasing age and irrespective of the number of affected lung sections. For this reason, early treatment of bronchiectases by a pulmonologist and specialised respiratory physiotherapists is key for long life-expectancy.

An article written by the PARI BLOG editorial team.

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