What Is the Most Common Cause of Bronchiectasis?

Chronic sinusitis may accompany bronchiectasis and symptoms may include the stuffy nose.

Bronchiectasis is an uncommon lung condition that usually occurs because the airways are wider than normal. This results in an increase in mucus which is difficult to cough up, and people with bronchiectasis may get lung infections more frequently. 

Symptoms of bronchiectasis include:

• Chronic cough with thick, sticky mucus
• A cough may last months to years
• Shortness of breath
• Wheezing
• Coughing up blood
• Frequent bronchitis or other lung infections
• Sharp chest pain that is worse when you take a breath
• Fever
• Weakness
• Fatigue
• Weight loss
• Rarely, dry cough

Chronic sinusitis may accompany bronchiectasis and symptoms may include: 

• Stuffy nose
• Yellow or green mucus from the nose
• Pain in the cheeks or forehead

Causes of bronchiectasis include the following:

• Bronchial obstruction
• Foreign body aspiration
• Cystic fibrosis or Young syndrome
• Primary ciliary dyskinesia
• Allergic bronchopulmonary aspergillosis (ABPA)
• Immunodeficiency states, both genetic and acquired, such as HIV/AIDS
• Congenital anatomic defects such as bronchopulmonary sequestration, Williams-Campbell syndrome (congenital cartilage deficiency), Mounier-Kuhn syndrome (tracheobronchomegaly), Swyer-James syndrome (unilateral hyperlucent lung), and yellow-nail syndrome
• Connective-tissue disorders
• Alpha1-antitrypsin (AAT) deficiency
• Autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, relapsing polychondritis, inflammatory bowel diseases (IBD) including Crohn’s disease and ulcerative colitis, sarcoidosis, and Marfan syndrome
• Idiopathic inflammatory disorders
• Autosomal dominant polycystic kidney disease (ADPKD)
• Traction from other processes
• Toxic gas exposure such as exposure to chlorine gas and ammonia

Bronchiectasis is diagnosed first with a history and physical exam. Tests that might be ordered include:

• Blood tests 
  • Immunoglobulin levels
  • Alpha1-antitrypsin (AAT) levels
  • Aspergillus precipitins 
  • Total IgE levels
  • Vitamin D levels
• Autoimmune screening tests
• Sputum culture
• Chest X-ray
• Computed tomography (CT) scan of your chest
• Pulmonary function tests
• Bronchoscopy

If bronchiectasis is caused by another medical condition, treating that condition will often help resolve bronchiectasis symptoms.

Treatment for bronchiectasis includes:

• Antibiotics for mild cases
  • Amoxicillin
  • Tetracycline
  • Trimethoprim-sulfamethoxazole
  • Newer macrolides (e.g., azithromycin or clarithromycin)
  • Second-generation cephalosporins
  • Fluoroquinolones
• Antibiotics for severe cases
  • Aminoglycosides (e.g., gentamicin, tobramycin) and
  • Antipseudomonal synthetic penicillin, third-generation cephalosporins, or fluoroquinolones
  • Tobramycin, for patients infected with mucoid Pseudomonas species
• Other medications
  • Bronchodilators
  • Corticosteroids
• Chest physiotherapy to help clear the airways
• Pulmonary rehabilitation
• Dietary supplementation
• Oxygen (reserved for hypoxemic patients with severe disease)
• Hospitalization for severe exacerbations
• Surgical therapies
  • Bronchial artery embolization
  • Removal of frequently infected or damaged parts of the lung (rare)
  • Lung transplant (only in the most severe cases)

Complications of bronchiectasis include:

• Recurrent pneumonia requiring hospitalization
• Empyema
• Lung abscess
• Progressive respiratory failure
• Cor pulmonale
• Chronic bronchial infection
• Pneumothorax
• Hemoptysis (rare, but can be life-threatening)

Before antibiotics, life expectancy for patients with bronchiectasis was reduced, and most patients died within 5 years following the onset of symptoms. 

However, with antibiotic therapies available today the outlook for patients with bronchiectasis is generally good. 

Bronchiectasis associated with cystic fibrosis has a poor prognosis. Other factors that contribute to a poor outcome and possible shortened life expectancy include age older than 65 years and prior use of long-term oxygen therapy.