Bronchiectasis (brong-ke-EK-ta-sis) is a condition in which damage to the airways causes them to widen and become flabby and scarred. The airways are tubes that carry air in and out of your lungs.
Bronchiectasis usually is the result of an infection or other condition that injures the walls of your airways or prevents the airways from clearing mucus. Mucus is a slimy substance that the airways produce to help remove inhaled dust, bacteria, and other small particles.
In bronchiectasis, your airways slowly lose their ability to clear out mucus. When mucus can’t be cleared, it builds up and creates an environment in which bacteria can grow. This leads to repeated, serious lung infections.
Each infection causes more damage to your airways. Over time, the airways lose their ability to move air in and out. This can prevent enough oxygen from reaching your vital organs.
Bronchiectasis can lead to serious health problems, such as respiratory failure, atelectasis (at-eh-LEK-tah-sis), and heart failure.
Bronchiectasis can affect just one section of one of your lungs or many sections of both lungs.
The initial lung damage that leads to bronchiectasis often begins in childhood. However, symptoms may not occur until months or even years after you start having repeated lung infections.
In the United States, common childhood infections—such as whooping cough and measles—used to cause many cases of bronchiectasis. However, these causes are now less common because of vaccines and antibiotics.
Now bronchiectasis usually is due to a medical condition that injures the airway walls or prevents the airways from clearing mucus. Examples of such conditions include cystic fibrosis and primary ciliary (SIL-e-ar-e) dyskinesia (dis-kih-NE-ze-ah), or PCD.
Bronchiectasis that affects only one part of the lung may be caused by a blockage rather than a medical condition.
Bronchiectasis can be congenital (kon-JEN-ih-tal) or acquired. Congenital bronchiectasis affects infants and children. It’s the result of a problem with how the lungs form in a fetus.
Acquired bronchiectasis occurs as a result of another condition or factor. This type of bronchiectasis can affect adults and older children. Acquired bronchiectasis is more common than the congenital type.
Currently, bronchiectasis has no cure. However, with proper care, most people who have it can enjoy a good quality of life.
Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor starts treating bronchiectasis and any underlying conditions, the better your chances of preventing further lung damage.
How Is Bronchiectasis Diagnosed?
Your doctor may suspect bronchiectasis if you have a daily cough that produces large amounts of sputum (spit).
To find out whether you have bronchiectasis, your doctor may recommend tests to:
· Identify any underlying causes that require treatment
· Rule out other causes of your symptoms
· Find out how much your airways are damaged
Diagnostic Tests and Procedures
Chest CT Scan
A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is the most common test for diagnosing bronchiectasis.
This painless test creates precise pictures of your airways and other structures in your chest. A chest CT scan can show the extent and location of lung damage. This test is also known as chest CT, x ray computed tomography (x ray CT), or computed axial tomography scan (CAT scan).
A chest CT scan is a more detailed type of chest x ray. This painless imaging test takes many detailed pictures, called slices, of your lungs and the inside of your chest. Computers can combine these pictures to create three-dimensional (3D) models to help show the size, shape, and position of your lungs and structures in your chest. This imaging test is often done to follow up on abnormal findings from earlier chest x rays. A chest CT scan also can help determine the cause of lung symptoms such as shortness of breath or chest pain, or check to see if you have certain lung problems such as a tumor, excess fluid around the lungs that is known as pleural effusion, pulmonary embolism, emphysema, tuberculosis, and pneumonia.
Your chest CT scan may be done in a medical imaging facility or hospital. The CT scanner is a large, tunnel-like machine that has a table. You will lie still on the table and the table will slide into the scanner. Talk to your doctor if you are uncomfortable in tight or closed spaces to see if you need medicine to relax you during the test. You will hear soft buzzing or clicking sounds when you are inside the scanner and the scanner is taking pictures. You will be able to hear from and talk to the technician performing the test while you are inside the scanner. For some diagnoses, a contrast dye, often iodine-based, may be injected into a vein in your arm before the imaging test. This contrast dye highlights areas inside your chest and creates clearer pictures. You may feel some discomfort from the needle or, after the contrast dye is injected, you may feel warm briefly or have a temporary metallic taste in your mouth.
Chest CT scans have some risks. In rare instances, some people have an allergic reaction to the contrast dye. There is a slight risk of cancer, particularly in growing children, because the test uses radiation. Although the amount of radiation from one test is usually less than the amount of radiation you are naturally exposed to over three years, patients should not receive more CT scans than the number that clinical guidelines recommend. Another risk is that chest CT scans may detect an incidental finding, which is something that doesn’t cause symptoms but now may require more tests after being found. Talk to your doctor and the technicians performing the test about whether you are or could be pregnant. If the test is not urgent, they may have you wait to do the test until after your pregnancy. If it is urgent, the technicians will take extra steps to protect your baby during this test. Let your doctor know if you are breastfeeding because contrast dye can pass into your breast milk. If you must have contrast dye injected, you may want to pump and save enough breast milk for one to two days after your test or you may bottle-feed your baby for that time.
Chest X Ray
This painless test creates pictures of the structures in your chest, such as your heart and lungs. A chest x ray can show areas of abnormal lung and thickened, irregular airway walls.
Other Tests
Your doctor may recommend other tests, such as:
· Blood tests. These tests can show whether you have an underlying condition that can lead to bronchiectasis. Blood tests also can show whether you have an infection or low levels of certain infection-fighting blood cells.
· A sputum culture. Lab tests can show whether a sample of your sputum contains bacteria (such as the bacteria that cause tuberculosis) or fungi.
· Lung function tests. These tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. Lung function tests help show how much lung damage you have.
· A sweat test or other tests for cystic fibrosis.
Pulmonary Function Tests
Also known as lung function tests.
Pulmonary function tests, or PFTs, measure how well your lungs work. They include tests that measure lung size and air flow, such as spirometry and lung volume tests. Other tests measure how well gases such as oxygen get in and out of your blood. These tests include pulse oximetry and arterial blood gas tests. Another pulmonary function test, called fractional exhaled nitric oxide (FeNO), measures nitric oxide, which is a marker for inflammation in the lungs. You may have one or more of these tests to diagnose lung and airway diseases, compare your lung function to expected levels of function, monitor if your disease is stable or worsening, and see if your treatment is working.
The purpose, procedure, discomfort, and risks of each test will vary.
- Spirometry measures the rate of air flow and estimates lung size. For this test, you will breathe multiple times, with regular and maximal effort, through a tube that is connected to a computer. Some people feel lightheaded or tired from the required breathing effort.
- Lung volume tests are the most accurate way to measure how much air your lungs can hold. The procedure is similar to spirometry, except that you will be in a small room with clear walls. Some people feel lightheaded or tired from the required breathing effort.
- Lung diffusion capacity assesses how well oxygen gets into the blood from the air you breathe. For this test, you will breathe in and out through a tube for several minutes without having to breathe intensely. You also may need to have blood drawn to measure the level of hemoglobin in your blood.
- Pulse oximetry estimates oxygen levels in your blood. For this test, a probe will be placed on your finger or another skin surface such as your ear. It causes no pain and has few or no risks.
- Arterial blood gas tests directly measure the levels of gases, such as oxygen and carbon dioxide, in your blood. Arterial blood gas tests are usually performed in a hospital, but may be done in a doctor’s office. For this test, blood will be taken from an artery, usually in the wrist where your pulse is measured. You may feel brief pain when the needle is inserted or when a tube attached to the needle fills with blood. It is possible to have bleeding or infection where the needle was inserted.
- Fractional exhaled nitric oxide tests measure how much nitric oxide is in the air that you exhale. For this test, you will breathe out into a tube that is connected to the portable device. It requires steady but not intense breathing. It has few or no risks.
Other tests may be needed to assess lung function in infants, children, or patients who are not able to perform spirometry and lung volume tests. Before your tests, you may be asked to not eat some foods or take certain medicines that can affect some pulmonary function test results.
Bronchoscopy
If your bronchiectasis doesn’t respond to treatment, your doctor may recommend bronchoscopy (bron-KOS-ko-pee). Doctors use this procedure to look inside the airways.
During bronchoscopy, a flexible tube with a light on the end is inserted through your nose or mouth into your airways. The tube is called a bronchoscope. It provides a video image of your airways. You’ll be given medicine to numb your upper airway and help you relax during the procedure.
Bronchoscopy can show whether you have a blockage in your airways. The procedure also can show the source of any bleeding in your airways.
Bronchoscopy is a procedure that looks inside the lung airways. It involves inserting a bronchoscope tube, with its light and small camera, through your nose or mouth, down your throat into your trachea, or windpipe, and to the bronchi and bronchioles of your lungs. This procedure is used to find the cause of a lung problem. It can detect tumors, signs of infection, excess mucus in the airways, bleeding, or blockages in the lungs. It also can allow your doctor to take samples of mucus or tissue for other laboratory tests, as well as to insert airway stents, or small tubes, to keep your airway open to treat some lung problems.
The procedure is performed using a flexible bronchoscope or a rigid bronchoscope. Flexible bronchoscopy is more common than rigid bronchoscopy, and flexible bronchoscopy usually does not require general anesthesia. Before the procedure, you will be given medicine to relax you. A liquid medicine also will be given to numb your nose and throat. If you have low blood oxygen levels during the procedure, you will be treated with oxygen therapy. If you have a lot of bleeding in your lungs or a large object is stuck in your airway, you may require rigid bronchoscopy in a hospital operating room under general anesthesia.
After the procedure, you will be monitored to make sure you don’t have complications. You may experience a sore throat, cough, or hoarseness that will go away with time. If you had the procedure as an outpatient, you likely will be able to go home after a few hours, but you will need a ride home because of the medicines or anesthesia you received. You will need to follow up with your doctor after the procedure to get your results.
Bronchoscopy is usually safe, but there is a small risk for fever, minor bleeding, or pneumonia. Pneumothorax, or collapsed lung, is a rare but serious side effect that can be treated. Your doctor may do a chest x ray after the procedure to check for lung problems
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