Bronchiectasis: symptoms, treatment and living with it

The NHS says the main symptoms are a cough that does not go away, coughing up a lot of phlegm (clear, white, yellow or green) and frequent chest infections in which symptoms worsen for a few days or weeks and you may feel generally unwell. Other symptoms include wheezing, shortness of breath, crackling, snoring-like or high-pitched sounds when breathing, tiredness, coughing up blood and chest pain. CKS lists daily expectoration of large volumes of purulent sputum, cough, breathlessness, haemoptysis and chest pain between exacerbations.

CKS says bronchiectasis should be suspected in adults with persistent production of mucopurulent sputum, a cough lasting longer than 8 weeks, rheumatoid arthritis or inflammatory bowel disease with a chronic productive cough, or COPD with frequent exacerbations. In children it lists a chronic moist cough that does not respond to 4 weeks of antibiotics, a wet cough over 6 weeks, severe or recurrent pneumonia and asthma that does not respond to treatment.

The NHS says bronchiectasis cannot usually be cured, so the aim is to manage symptoms and stop them getting worse, supported by a GP, nurse, physiotherapist and sometimes a specialist doctor, with check-ups and tests at least once a year. A specialist physiotherapist teaches breathing techniques for clearing phlegm, sometimes with a hand-held vibrating device, usually done every day; a nebuliser with salt solution may help if phlegm is hard to cough up; pulmonary rehabilitation may be offered if breathlessness is a problem.

When you are unwell you will usually be asked for a phlegm sample, and infections are treated with antibiotics. The NHS says you may be given antibiotics to keep at home as a rescue pack with instructions on when to take them, and that if you get more than 3 chest infections a year a specialist may recommend long-term antibiotics to prevent them. CKS says an infective exacerbation can usually be managed in primary care, with previous microbiology guiding antibiotic choice. Other options for severe disease include inhalers, oxygen therapy, surgery to treat lung damage and lung transplant. Take antibiotics exactly as prescribed.

The NHS says bronchiectasis is a condition where the airways in the lungs are damaged and produce a lot of phlegm. NICE Clinical Knowledge Summaries (CKS) describe it as a chronic disease marked by permanent widening of the bronchi due to damage to the bronchial wall, caused by inflammatory damage to the airways and associated with a range of underlying diseases. Because mucus pools in the widened airways, infections are common, and each infection can cause more damage.

The NHS lists a severe infection such as pneumonia, tuberculosis, measles, whooping cough or COVID-19, another lung condition such as asthma or COPD, breathing in something that damages the lungs, a problem with the immune system, and conditions such as rheumatoid arthritis and inflammatory bowel disease (ulcerative colitis, Crohn's disease). For many people the cause is not clear, which is why a specialist may arrange further tests to look for one.

A GP will listen to your chest and may arrange a phlegm sample to check for infection, a chest X-ray, spirometry and blood tests, the NHS says. If these suggest bronchiectasis you are referred to a specialist, where a CT scan is used to confirm the diagnosis and other tests may look for the cause. CKS lists sputum culture, chest X-ray, spirometry, oxygen saturation and a full blood count as the initial investigations, and says all people with suspected bronchiectasis should be referred to a respiratory physician to confirm the diagnosis and determine the underlying cause.

NICE Clinical Knowledge Summaries lists signs that should make a clinician suspect bronchiectasis in children: a chronic moist or productive cough that does not respond to 4 weeks of antibiotics, a wet cough lasting over 6 weeks, severe or recurrent pneumonia, and asthma that does not respond to treatment. It also says that all people with suspected bronchiectasis should be referred to a respiratory physician to confirm the diagnosis.

If your child has a wet cough that does not go away or repeated chest infections, see a GP.

The NHS says to see a GP if you think you could have bronchiectasis or you have had a cough for more than 3 weeks. It advises an urgent GP appointment or NHS 111 if your cough is very bad or quickly gets worse, you are coughing up a few small spots, flecks or streaks of blood, you are short of breath or more than usual, or you have a known diagnosis and develop chest infection symptoms such as a high temperature or chest pain when breathing or coughing. Call 999 or go to A&E if you cough up more than just a few spots or streaks of blood, which could be serious bleeding in the lungs, or have severe difficulty breathing; do not drive yourself.

The NHS advises exercising regularly, eating a balanced diet and keeping to a healthy weight, washing hands regularly, staying away from people with colds and flu, not smoking, and having regular vaccinations: flu every year, plus pneumococcal and COVID-19 vaccines as recommended by your GP. It also says that having bronchiectasis together with asthma or COPD is common, and that how it affects life depends on how severe symptoms are and how often infections occur; in rare cases it can be life-threatening, while some people have less severe symptoms that are well managed.

Long-term care is delivered through GP, respiratory and physiotherapy services. Private respiratory consultations and CT scans can speed diagnosis, but ongoing airway clearance teaching and annual review are the core of management, so ask who will provide those. If you are already diagnosed, check that you have a rescue plan in writing and know which symptoms mean you should send a sputum sample.