About bronchiectasis in adults

Bronchiectasis in adults

The information in this section will give you an overview of bronchiectasis in adults and what steps to take if you think your patient in primary care might have the condition.

This is not a substitute for completing an appropriate respiratory assessment module.  For advice and support on choosing the right course for you, please see our training and development page.

What is Bronchiectasis?

Bronchiectasis is a chronic lung condition that often begins:

• after the airways are damaged by a severe infection or
• because of prolonged inflammation from another cause.

The airway damage leads to abnormal widening of the bronchi, making it difficult for the lungs to clear sputum effectively.  This causes sputum to build up. The cilia — tiny hair-like structures that help move mucus — are also impaired, making sputum retention worse.

The built-up sputum creates a perfect environment for bacteria to grow, leading to repeated chest infections and ongoing inflammation.  In response, the immune system sends neutrophils to fight infection, but these cells can release substances that worsen airway damage. 

Over time, this creates more damage to the airway walls, making them even wider and causing scarring. This process is known as the "vicious cycle" of bronchiectasis. Infections and inflammation keep feeding into each other, making the condition worse over time

Bronchiectasis may affect many areas of the lung, or it may appear in only one or two areas. Typically, bronchiectasis causes widening of medium-sized airways, but often smaller airways become scarred and destroyed.

Treatment focuses on breaking the ‘vicious cycle‘ — by helping to clear sputum, reduce inflammation, and prevent infections.

Facts about bronchiectasis

• Around 1 in 100 adults in the UK have bronchiectasis.
• It’s more common in women than in men.
• Around 60% of people diagnosed with bronchiectasis are over 70 years old
• People with bronchiectasis are nearly twice as likely to die as people without the condition 

Symptoms of bronchiectasis

Bronchiectasis symptoms can range from mild to life limiting and vary in severity from person to person.  They include:

A chronic productive cough

Most patients have a chronic cough, often producing large volumes of purulent sputum daily.  Purulent sputum is sputum that is thick, opaque, and often yellow or green in colour, indicating the presence of pus. Built up sputum can cause repeated infective exacerbations requiring oral, inhaled or intravenous antibiotics.  

Chronic cough can be debilitating, and cause incontinence, chest pain and sleep disturbance. Cough can prevent patients from socialising if they feel self-conscious, leading to isolation and loneliness. 

Breathlessness

Many patients experience breathlessness due to airways obstruction caused by scarring from inflammation and repeated infections.

Fatigue

Fatigue in bronchiectasis is common and multifactorial, caused by chronic inflammation, frequent infections, increased work of breathing, and poor sleep. It’s often made worse by physical deconditioning, anxiety or depression, and the side effects of medication.

Weight loss

Chronic inflammation and frequent infections can cause weight loss. In some cases, reduced appetite, the effort of breathing, and persistent coughing can also make it harder to eat enough, increasing the risk of malnutrition.

Haemoptysis (coughing up blood) 

A less common, complication of bronchiectasis and can range from mild streaks of blood in the sputum to life-threatening bleeding. Chronic inflammation damages blood vessels in the airway walls and makes the bronchial arteries fragile and more likely to rupture.

Who does bronchiectasis affect?

Bronchiectasis can affect both children and adults.  

For around 60% of cases, there is a known cause such as a past infection or an underlying condition but for others, no cause is found and these cases are called idiopathic.

Severe lower respiratory tract infections such as pneumonia, whooping cough, pulmonary tuberculosis, COVID-19, influenza, or other viral infections can cause bronchiectasis.

Bronchiectasis is more likely in patients who have a persistent cough who also have a diagnosis of:

• COPD
• difficult to treat asthma
• rheumatoid arthritis
• chronic rhinosinusitis
• inflammatory bowel disease
• immunosuppressive diseases
• connective tissue diseases

or patients who have persistent pseudomonas aeruginosa infections in their sputum .

If a patient with COPD has a history of two or more COPD exacerbations per year and a previous positive sputum sample for pseudomonas aeruginosa whilst stable, then this increases their risk of developing bronchiectasis.