Bronchiectasis is the clinical term that defines the irreversible, progressive dilation, expansion, inflammation, and scarring of the bronchi (the tubes conducting air to the lungs), which eventually lead to airway obstruction and impaired mucociliary clearance, causing further damage.

Bronchiectasis often occurs secondary to another medical condition such as cystic fibrosis, sinopulmonary disorders, respiratory tract infections, and allergies. It results in distortion and damage to one or more of the conducting airways and generally involves a single lobe, a segment, or a sub-segment of the lungs.

Common symptoms include productive sputum along with a cough (occasionally tinged with blood), chest pain, shortness of breath, wheezing, and fatigue. Exacerbations (flare-ups) are common, especially with underlying bacterial infections, increased mucus production, more viscous sputum production, and worsening of respiratory and pulmonary functions.

Diagnosing bronchiectasis involves sputum culturing and analysis, chest radiography, computed tomography (CT) scanning, measuring vitamin D levels (a recent diagnostic measure), pulmonary function tests, and a physical exam to verify the underlying condition.

Treating the conditions includes combinations of bronchodilators, corticosteroids, and antibiotics (depending on the intensity and severity of the symptoms; anti-pseudomonal and anti-mycobacterial antibiotics are the common choices due to underlying cystic fibrosis or tuberculosis, respectively).

Supportive nutritional therapy, physical fitness, and maintenance of a healthy diet are equally important to increase the quality of life during and after therapy.


The causative agents of bronchiectasis can be broadly divided into two classes:

Congenital causes

  • Impaired mucociliary clearance due to dysfunctional cilia lead to bronchiectasis in many cases. Some of the major conditions associated with this include primary ciliary dyskinesia and Kartagener syndrome.
  • Congenital immunodeficiency syndromes such as X-linked agammaglobulinemia — immunoglobulin A, G, E, and M (IgA,IgG, IgE, IgM, respectively) deficiencies — lead to impaired immune systems and immune dysfunctions. This leads to repeated pulmonary infections and an inability to clear the system, which in turn leads to bronchiectasis.
  • Congenital anatomic defects, including Swyer-James syndrome (unilateral hyper lucent lung), Mounier-Kuhn syndrome (tracheobronchomegaly), Williams-Campbell syndrome (congenital cartilage deficiency), and others can lead to bronchopulmonary sequestration. This is a condition where a tissue developing in the lungs is not connected to the pulmonary artery supply and consequently is disconnected from the normal bronchial airway, interrupting pulmonary functions, eventually leading to lower-respiratory infections and bronchiectasis.
  • Cystic fibrosis is another congenital, autosomal recessive condition which is detected in early or late childhood or in adults. It’s caused from a mutation in the cystic fibrosis transmembrane regulator (CFTR) protein, leading to impaired transport of sodium and chloride across membranes. This is accompanied by thick mucous that clogs the lungs and harbors harmful Pseudomonas aeruginosa, leading to bronchiectasis. Many cases of bronchiectasis are secondary to cystic fibrosis.
  • Young’s syndrome is another genetic variation of cystic fibrosis, also found to be a contributor in the development of bronchiectasis.

Acquired causes

  • Bacterial infections are one of the primary causes that lead to the development of bronchiectasis. The most common bacteria involved include Staphylococcus aureus, Mycobacterium tuberculosis, Klebsiella pneumoniae, Hemophilus influenzae , Mycoplasma pneumoniae and Pseudomonas aeruginosa. Also contributing to the disease are viruses like measles, adenovirus, influenza, and herpes. Tuberculosis, apart from cystic fibrosis, is a pivotal condition leading to bronchiectasis.
  • Non-tuberculous bacteria like those included within the Mycobacterium avium complex (MAC) has been recognized as a causative agent in women over age 6o with no other history of any pulmonary disorder.
  • Non-cystic fibrosis bronchiectasis has been found to affect a certain population of people with chronic Pseudomonas and Hemophilus infections, where the bacteria lives in the airways, leading to biofilm formation and airway obstruction, eventually leading to bronchiectasis.
  • HIV is another notable background condition recognized as responsible for the development of pulmonary disorders including bronchiectasis. A simple explanation might be the impaired and compromised immune system which makes the patients susceptible to all kinds of infections, with repeated exacerbations.
  • Allergic bronchopulmonary aspergillosis (ABPA) is a condition manifested by the allergic reaction caused by the inhalation of the fungal spores of Aspergillus sp. The hyphae of these spores are found to clog the pulmonary airways, which cause excess mucus secretion and eventually lead to central-airway bronchiectasis (thin-walled bronchiectasis affecting the small and medium sized airway passages). A method to distinguish this particular condition from other types is the detection of eosinophilia — the deficiency, hypersensitivity and extreme reaction to inhaled corticosteroids.
  • Aspirations, predisposed by altered mental status, leading to aspiration of unchewed food, peptic acid and microbes from the stomach, can lead to post-obstructive pneumonia and subsequent bronchiectasis.
  • Bronchial obstruction caused as a result of non-malignant endobronchial tumors, bronchial stenosis from infections, mechanical traction from scarring of surrounding lung parenchyma, angulation of lobar bronchus (right or middle lobe obstruction), among others, also lead to development of bronchiectasis.
  • Autoimmune and idiopathic inflammatory diseases like rheumatoid arthritis, ankylosing spondylitis, relapsing polychondritis, sarcoidosis, and systematic lupus erythematosus have also been noted as indirect precursors to the development of pulmonary disorders including endobronchial inflammation, pulmonary parenchymal scarring, and extrinsic compression of bronchi, all of them eventually leading to bronchiectasis.
  • Connective tissue disorders like Marfan syndrome can also lead to bronchiectasis in a number of cases. An explanation of this is the weakening of the connective tissue constituting the broncho-pulmonary walls, which predisposes bronchiectasis.
  • Other less common acquired causes include exposure to toxic gases, onset of an irritable bowel disease (Crohn’s disease) and alpha-1-antirypsin deficiency, which causes irreversible damage to bronchi, predisposing bronchiectasis.


No specific systemic data is available for the number of people affected by bronchiectasis. This may be due to the fact that it is most commonly recognized as a secondary complication to some of the major diseases, such as cystic fibrosis and tuberculosis. Also, because of non-specific symptoms, most cases are left underdiagnosed in their initial stages. Non-cystic fibrosis and atypical mycobacterial bronchiectasis affect around 50 percent of the patients associated with the condition.

Data from the 1980s suggests a total prevalence of 100,000 cases in the U.S., but this has gradually decreased since the introduction of vaccines and the spread of awareness for immunization in the 20th century. Generally, countries with greater access to medical benefits, higher socioeconomic status, and better education and awareness have a lower prevalence of the disease.

Apart from affecting children (congenital cases), bronchiectasis normally affects people older than 50, and is more common in women than men.

Signs and symptoms

The most common symptoms of bronchiectasis are the production of mucoid sputum, occurring in almost 90 percent of patients, with daily production of sputum being reported by more than 70 percent of patients. The sputum is generally colorless and odorless. Occasional production of blood-tinged sputum (hemoptysis) is also a possibility in patients with acute infection and damage to the pulmonary airway vasculature. Once infected by bacteria, the sputum can turn greenish, with an offensive odor.

At one time, the amount of sputum produced used to be a diagnostic indicator of the intensity of bronchiectasis. Now, however, radiographic exams are taken as the gold standard for diagnosis.

Other common symptoms include dyspnea, chest pain, wheezing, weight loss, and fatigue (from the increased energy required as a result of constant coughing). Fever might be an indicator on the onset of inflammation and acute infection.


Radiographic exams are the most commonly accepted means of diagnosis as far as broncho-pulmonary conditions are concerned. According to the recommendations by the British Thoracic Society, every case of non-cystic fibrosis should be confirmed by a computed tomography (CT) scan analysis.

For the complete assessment of a case of bronchiectasis, clinicians should check for the consistent production of sputum first, which is one of the major indicators of the disease. On a stethoscopic exam, the physician is most likely to find crackles in people with acute infection, and wheezing sounds in patients with airway obstruction and endobronchial damage. In patients with very severe forms of the disease, digital clubbing and cyanosis (as a result of respiratory obstruction) is observed.

A chest radiograph and CT scan shows the presence of a “tree-in-bud” appearance (which refers to airway obstruction in radiologic terms), which is another strong indicator of airway obstruction and subsequent bronchiectasis. The accuracy levels of high-resolution CT (HRCT) scans are very high with a sensitivity and specificity of 84 percent to 97 percent, and 82 to 99 percent, respectively. A typical finding in HRCT is the expansion of the bronchial lumen to 1.5 times the adjacent vessel.

A bronchoscopy is conducted when the radiographic findings are not accurate enough to confirm the condition. But this is very rare, given the high success rates of HRCT scans.

A medical history of the patient should be taken to check for pre-disposing conditions which could lead to bronchiectasis (cystic fibrosis, tuberculosis, respiratory tract infections, allergies, auto-immune disorders).

To confirm findings, the patient’s blood and sputum cultures should be analyzed. The patient’s immunoglobulin levels (IgM, IgA, IgG, IgE) should also be analyzed to detect an underlying immune deficiency (hypogammaglobulinemia). Patients with suspected cystic fibrosis undergo a sweat test to analyze the amount of sodium and chloride excreted through sweat.

Pulmonary function tests are conducted to detect the degree of damage to pulmonary functions as a result of bronchiectasis.


Treating bronchiectasis includes taking care of current symptoms, reducing their severity so that exacerbations aren’t as frequent (or are avoided completely, depending on the severity), and reducing morbidity and mortality by caring for the underlying conditions. Early diagnosis helps in planning a more effective therapeutic intervention.

Common medications prescribed by physicians include a combination of antibiotics, bronchodilators, expectorants (mucus thinning agents to improve mucociliary clearance), and free oxygen therapy if necessary. Surgical procedures are also conducted if necessary in severe cases.

For mild to moderate cases, oral and inhaled antibiotics are often preferred, but in cases of severe complications, intravenous doses are administered. Commonly used antibiotics include amoxicillin, tetracycline, trimethoprim-sulfamethoxazole, and macrolides.

In cases of cystic fibrosis-induced bronchiectasis, a stronger antibiotic regimen and an antipseudomonal synthetic penicillin, a third-generation cephalosporin, or a fluoroquinolone are often prescribed. For MAC-induced bronchiectasis, a combination of clarithromycin, rifampin, ethambutol, and possibly streptomycin are prescribed as standard therapy by the American Thoracic Society.

Additionally, physical means (use of percussion, vibrations, and shaking, to dislodge sputum from the chest walls) might be performed in cases of emergency to clear chest congestion.

Surgical intervention is sometimes necessary in people with severe complications. Indicators for surgical interference include extreme hemoptysis, an ineffective treatment regimen with antibiotics, presence of a foreign body or a non-malignant tumor, severe infections with MAC, Pseudomonas or Aspergillus sp.

Maintaining a healthy lifestyle contributes to lower morbidity, mortality rates, and an increased lifespan for patients. This incluedes not smoking and not coming in contact with second-hand smoke, vaccinations against pneumonia and influenza, and adequate nutritional supplements and hydration.

Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
Patrícia holds her PhD in Medical Microbiology and Infectious Diseases from the Leiden University Medical Center in Leiden, The Netherlands. She has studied Applied Biology at Universidade do Minho and was a postdoctoral research fellow at Instituto de Medicina Molecular in Lisbon, Portugal. Her work has been focused on molecular genetic traits of infectious agents such as viruses and parasites.
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  1. Dianne Granthen says:

    Wonderfully explained – answered all my questions, helping me to understand what is going on with a dear friend that was recently diagnosed with bronchiectasis. Trying to pronounce it is the most difficult obstacle – you should include that in your article!

  2. Nate says:

    Thank you, ive been told i have asthma and other things. I know have bronchitis,but i not understanding if they do surgery does it eliminate the problem or isf it just another quick fix? Thanks again for the information.

    • Tim Bossie says:

      You are welcome and we are glad that you were able to get some answers. Continue talking with your doctor, and if you have any other questions, do not hesitate to ask for second opinions and talk with other medical professionals.

    • Diane Hart says:

      My son was diagnosed with bronciectasist at 11 years of age and has since been on antibiotics constantly both oral and intrivinious. He copes very well most of the time but what can I do to help his quality of life. He is now 30. Is there anyway I could donate a lung? a lung transplant has never been mentioned.

  3. Seth Solomon says:

    I was diagnosed with bronchiectasis. The doctor performed a bronchoscopy as a first method to see what may be causing the Bronchiectasis. I am a little weary of the doctor as he did not read me the informed consent. I noticed the form where he said he did but I would remember if someone told me something was dangerous if they were going to perform a procedure on me. The issue of him doing a bronchoscopy after only one appointment made me wonder. I have no symptoms at all and I scored I thin 90 on A BREATH TEST. No reason was found as to be a primary cause to cause the bronchiectasis. I have not been prescribed anything by this doctor for it nor has any immunoglobulin test performed. However, he diagnosed me as a tobacco abuser, having COPD as well as several other things which I questioned. It would seem to me if anything that my HIV status might be the reason or the fact that I had tonsil cancer and the possibility of slight aspiration is also possible. What if anything should I say to the doctor. I am having a growing mistrust for him.

  4. Teresa says:

    I’m so confused. I was diagnosed after having a cough with a lot of phlegm for about 6 weeks. I had a CT scan and then a bronchosopy. I do have lupus. I have been on nebulizer treatments every 4-6 hours and Breo before bed. I was coughing up green phelm so was put on doxycycline a week ago. I’m not coughing at all now. Do I continue the nebulizer treatments?

    • Tim Bossie says:

      Hi Teresa… it sure sounds like you have been through a lot recently. We can’t say whether or not you should stay on the nebulizer, but would definitely talk to your doctor as soon as you can.

  5. Carolyn J. Smith says:

    I have asthma, productive/yellow (rhinitis of same color–all allergy based. I am on shots, nose drops, pills.
    I also have early bronchiectasis. I am told not to worry, unless I get an infection.
    The problem: if I take an antibiotic, my colon bleeds. Has done for years. I have mast cell issues, too, chronic diarrhea.
    Can I give myself antibiotic shots as I do allergy shots, if and when I get an infection? I understand the NCFB is progressive, and the asthma is permanent.

  6. Adrian McDonald says:

    I’m curious why you consider Vest Therapy for only emergent situations? If a person is dealing with hypersecretions, why not incorporate vest therapy into their daily regimen as an additional preventative therapy?

  7. Sandra Burd says:

    I have newly acquired bronchecthesas I want to know how long does it take this disease to become very debilitating I am 72

    • Tim Bossie says:

      We are sorry to hear that you have been diagnosed with this disease. However, we can not give any type of medical advice concerning a prognosis. We can say that there are many issues that would surround this like age, severity, and any other complications.

  8. Llevelyse Shepley says:

    I have had diagnosed bronchiectasis albeit mild, for a number of years now. Took sometime to be diagnosed though, and not before I had a few bouts of pneumonia despite having vaccination. There is no real explanation why I have this, as had no whooping cough, pneumonia as a child. Neither have I smoked. However I did have a really bad case of measles as a child. I am female and 72 years of age. I now manage it by doing what my mum use to say. Have enough sleep, eat well and that type of thing. I take a immune support tonic and pre/probiotics and an alkalising powder. I am on seretide 125mg one puff in the morning and 2 puffs at night. Also if needed, I have ventolin as I also have a component of asthma. I am always watchful.

  9. Theresa says:

    I was diagnosed with bronchiectasis as a child of 12. I have had two operations where the specialist removed half of my left lung and one third of the right lung. When I was 21 I began to cough up a little blood and then went back to the lung specialist and with the aid of a bronchoscopy he found that the disease had returned to my left lung. I am now 83 and have been told I now have bronchiectasis in the right lung. I have had CT scans and they find that I have couple of nodules in the base of my one lung. My ribs are broken as well. I was told that if I were younger my pulmonologist would operate again. I would like to move to the coast as I have more energy there but then I would be too far from my family. Otherwise thank the Lord I am ok. Theresa

  10. Theresa says:

    I wasjust diagnosed with copd , emphysema and Bronchiectasis. Surgery of lung found all this. Plus abnormal lung cysts. I am scared. Now on oxygen . help

  11. Stephen Phillips says:

    I was diagnosed almost two and a half years ago with the disease. The initial trigger was aspiration pneumonia, which I ignored for a month (constant coughing
    with purulent mucus). I have never had a fever, and never had any previous lung issue, a never smoker as well. Fast forward to this year, with three hospitalizations with pneumonia in this year alone, always a pseudomonas aeruginosa positive culture, along with nosocomial bugs after my hospital stays, and advancing disease progression on ct imaging, clearly I am losing ground. After my last hospital visit a “mid line” picc line was placed with 5 weeks of ceftazidime and oral cipro, and I have felt virtually normal for a month. I do 20 min of vest therapy twice daily, dulera, albuterol, and spiriva inhalers. For once in my life of 72 years, I cannot gain weight and am down 30 pounds, looking forward to some Christmas poundage, I hope. My pulmonologist is not encouraging, maybe a few years if my infections can be controlled. My research indicates being a man ( I won’t transition!), low weight (I am trying), frequent exacerbations etc. give a poorer prognosis. It is a time consuming fight, but I thank God I have the energy and desire to keep on keeping on. Steve, San Diego, Ca.

  12. Norman Kettlewell says:

    Can anyone explain , i was told i have Chronic Bronchial Sepsis . Dr said it was the same as Bronchiectasis , without the widening of the air ways . Is there anyone with the same condition . I would like to know how they cope with the condition , would be very grateful , at my wits end

  13. Baokhikhang says:

    Hi Tim,
    I had chronic bronchitis for 2 years. And I have just diagnosed with bronchiectais which is complication of chronic bronchitis. What can I do help my quality of life? What foods should I eat to preserve strength, boost immunity, and help you feel better?
    Thank for your advice.

    • Pat Lowe says:

      Plenty of vegetables, greens, berries, other fruit, eggs, butter, nuts, fish, not too much meat, good cereals such as muesli.

      Avoid pies, white bread, sugar, sweet drinks, deep-fried and battered food. Cook in olive oil, stir-fry vegetables and tofu with rice etc. Not too much bread of any kind, avoid cakes, sweet biscuits. Drink plenty of water every day. Go sparingly with alcohol — use as an occasional treat, not a daily habit. Don’t smoke.

      Hope this helps. If you don’t eat like this already, you can cultivate a taste for this sort of food. Eventually, you will dislike unhealthy food.

      I’ve had bronchiectasis for about 35 years — I manage it on advice from the doctor, do regular postural drainage, eat as above (with just occasional treats) and get plenty of exercise — mainly walking these days. Still in reasonably good health, which I attribute largely to my lifestyle, and good medical guidance. I’m almost 77. Good luck.

  14. Gina says:

    Hi Tim,
    Not sue if you are still replying here…

    I have a few ?s:
    “Tree-in-bud” pattern doesn’t necessarily mean active infection, does it? Can it just be from excess mucous from bronchiectasis?
    Also, can TIB pattern persist over time on CT, even if no infection?

    AND, are small nodules seen on CT normally associated with bronchiectasis? Are nodules also something that can just be in the lungs post infection and simply never go away?
    I ask because I was treated for MAI, and want to know what on CT is expected to, or can, remain the same on follow-up CT, even after clearing the infection.

  15. KmL says:

    Is it possible for a person to have Bronchiectasis now if he had a clear x-ray 5 months ago? Or should it have been diagnosed then?

  16. Gail says:

    I was diagnosed with bronchiectasis 8 years ago but I believe that it had been there many years before and not diagnosed. I have been on albuterol and for the last two years on a saline solution.
    I am now with a new dr. because I needed someone closer to my home. He did a ct scan and put me on budesonide and perforomist twice a day. These medications are quite expensive. Also I am waiting for a vest that has been ordered. Also expensive! I will have to tighten the budget in order to manage.
    Unfortunately, I am just learning about this disease through the internet.
    I am active and otherwise healthy for a 79 year old women and hope that these new meds and the vest will keep me well so that I can enjoy my 6 grandchildren.

  17. Lyn Nikkelson says:

    I was diagnosed with Upper Left Fibrosis and mild Cyndrical Bronchiectasis after a Radical Mastectomy on the Left side. I have SLE with Thrombocytopenia and Anticardilipin. So I,m at somewhat of a disadvantage.
    How can I best manage this?

  18. Deborah says:

    Great page to give to friends and family after my diagnosis. One concern with it though – Crohns disease is listed as Irritable Bowel – it is not. Ulcerative Colitis and Crohns are inflammatory bowel diseases (they can result in destruction of different parts of the digestive tract) – irritable bowel is not; a very important distinction.
    And both UC and Crohns have been implicated in the development of bronchiectasis, especially UC.

  19. I was recently diagnosed with mild Bronchiectasis with 2 nodules on left lung which doctor says has remained stable for almost a year. Sputum tests showed no infection, therefore the pulmunologist informed me I would not be taking any medicine. I am currently on Spiriva inhaler. I am totally confused about the entire thing, even though the doctor explained everything to me. I am scheduled to have a bronchoscopy only because every now and then because there is blood in the mucus I cough up.

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