Bronchiectasis: chronic dilatation and inflammation of the bronchi

Causes and risk factors

The condition can arise after serious lung infections, from congenital or genetic disorders, or because of impaired airway clearance. Common contributors include:

• Post-infectious damage (bacterial pneumonia, severe childhood infections, tuberculosis)
• Genetic diseases (for example, cystic fibrosis)
• Primary ciliary dyskinesia and other disorders of mucociliary clearance
• Immune deficiencies and obstructing lesions in the airway

Pathology and clinical features

Bronchiectasis results from a vicious cycle of infection, inflammation and structural airway damage. Typical symptoms are a chronic productive cough, large-volume sputum, recurrent chest infections, breathlessness and sometimes haemoptysis. Physical signs and recurring exacerbations drive decline in lung function over time.

Diagnosis and investigation

High-resolution computed tomography (HRCT) of the chest is the gold standard: it shows bronchial dilatation, bronchial wall thickening and sometimes mucus plugging. Pulmonary function testing usually demonstrates an obstructive pattern. Microbiology of sputum helps to guide antibiotic therapy.

Treatment and outlook

Management aims to control infection, improve airway clearance and treat underlying causes. Typical measures include:

• Regular chest physiotherapy and techniques to assist sputum clearance
• Targeted antibiotics for exacerbations; long-term macrolide therapy in selected patients
• Bronchodilators, inhaled therapies and vaccinations to reduce infections
• Surgical resection for localized, severe disease in some cases

Prognosis varies widely: many people maintain stable symptoms with proper care, while others experience progressive lung damage, recurrent hospitalizations or complications such as respiratory failure. Multidisciplinary follow-up and individualized treatment plans improve outcomes.