Bronchiectasis means that the airways have become wider than usual, often because they have been damaged or your child was born with a problem with the airways.
Normally, the lungs make a small amount of mucus that helps to trap bacteria or particles that we inhale and keep the airways clean. The mucus is cleared by tiny hairs called cilia that “flick” the mucus out of the lungs.
In bronchiectasis, the mucus is not cleared properly because too much mucus is made and the cilia do not clear the mucus as well. The mucus becomes trapped in the lung and can become infected.
As a result your child may have a cough, which might produce mucus (called sputum when it is coughed up) and might suffer from frequent chest infections needing antibiotics.
Bronchiectasis is a long term condition and the damage is usually permanent. Treatment aims to prevent infections, reduce symptoms and therefore reduce any further damage from happening.
There are many ways in which bronchiectasis can develop. The most common in children are:
- Severe infections like pneumonia, tuberculosis or whooping cough. The infection damages the lung leaving a permanent area of scarring and bronchiectasis
- A problem with the immune system which makes your child more prone to chest infections
- A problem with lung development - some children are born with problems in the way the lung is made, such as not having enough cartilage. This means that bronchiectasis develops because the lungs grow in an abnormal way
- Problems with the clearance of mucus from the lungs, such as the inherited diseases primary ciliary dyskinesia (PCD) or cystic fibrosis (CF).
- An obstruction to the lungs because of something that the child inhaled
- In at least one third of children it is not possible to find a cause for the bronchiectasis
Your paediatrician will arrange tests to try to find out why the bronchiectasis has developed.
Children will be affected by bronchiectasis in different ways. In some cases the condition will be mild and there will be few symptoms. In other cases the condition may be more severe and may have a greater impact on the individual child.
Common symptoms include a cough with mucus. Children will often swallow mucus when they are young. Mucus can be quite hard to digest and so if there is a lot of mucus they may vomit at times. This can also be caused by intense coughing.
Children may also feel or appear short of breath at times and might have noisy breathing due to mucus or wheezing.
Young children may have lower growth or difficulty putting on weight.
Bronchiectasis is usually a chronic condition which means your child will need to learn how to clear mucus and keep their airways healthy. They will need to manage this throughout their life.
Treatment involves a few different aspects:
- Treating the underlying cause
- Keeping the airways healthy by clearing the mucus
- Treating infection
- Preventing infections
Treating the underlying cause, might involve strengthening the immune system if there is an immune system problem, or removing a foreign body if a blockage of the airways caused the bronchiectasis.
Chest clearance exercises will be taught to you and your child, usually by a trained physiotherapist. They will advise you on how often the exercises should be performed and for how long.
Treating infection involves using antibiotics. If your child develops symptoms of a chest infection, such as coughing more, a worsening of the colour or thickness of the mucus or an increase in other symptoms like tiredness and breathlessness, they may need an antibiotic. Treating chest infections quickly when they happen helps to limit lung damage. If infections are happening often your doctor might recommend taking an antibiotic regularly as a tablet or an inhaler or nebuliser to try to stop them from happening. Inhalers are also sometimes given to open up the airways and reduce wheezing and breathlessness.
Preventing infections is also important. The flu vaccine is important to get every year as flu can be severe in children with bronchiectasis. Teach your child to wash their hands before meals and after playing. If friends or relatives have viral infections, it is best to advise them not to visit as children with bronchiectasis may have an exacerbation when exposed to cold and flu viruses.
- Make sure your child sees a doctor regularly who has knowledge and experience in treating children with bronchiectasis. If they are not doing this at the moment, consider asking your doctor to refer you to a specialist. This is especially important if your child has a lot of symptoms or are having frequent exacerbations.
- Help your child to stay active: exercise helps to clear the chest and keeps the lungs healthy. Do not allow bronchiectasis to hold your child back - encourage them to do as much as they are able.
- Make sure your child eats a healthy diet: coughing and fighting infection uses up energy and so children with bronchiectasis can be tired. Ensure they are eating plenty of food and maintaining a healthy weight.
- Make sure your child drinks plenty: if they become dehydrated, their mucus will become thicker and harder to clear, so make sure they drink plenty of water.
- Do not smoke or allow your child to be exposed to smoke: second hand smoke is harmful to the lungs and so it is important that children with bronchiectasis are not exposed to cigarette smoke. As your child grows older, ensure they understand the importance of not taking up smoking.
- Encourage your child to do their exercises and take their medications: taking medications and doing regular chest exercises can be very difficult for children, and many children go through periods where they do not want to continue taking treatments or doing these exercises. Keep emphasising the importance of keeping their lungs healthy and the benefits of doing so. Support them when they are having difficulties and work with your healthcare professionals to find the best ways of fitting treatments into your child's life.
What research is there into the root cause and treatment options?
How can I get involved in clinical trials.
- Make time for yourself while caring for your child - if you are not well then you cannot look after your child.
- Get a good relationship with a physiotherapist who can regularly review techniques and suggest different ways of doing physiotherapy to fit in with changing lifestyles as your child grows.
- If you do not know what the cause of your child's bronchiectasis is then push for a diagnosis.
- Review your child regularly to try and limit the development of the condition. Do not just treat symptoms when they have an exacerbation.