How do my lungs work?

You have two lungs, which sit on either side of the heart within the ribcage. Each lung is made up of sections called lobes. They are connected to the nose and mouth by the windpipe (trachea).

The lungs' job is to bring oxygen into the body and to remove carbon dioxide. Oxygen is a gas that provides us with energy, while carbon dioxide is a waste product of the body.

When you breathe in, air passes through a series of connecting tubes (called bronchi or airways) which are designed to take the air towards the bloodstream. The air meets the bloodstream at tiny air sacs called alveoli.

How do my lungs stay clear of infection?

As well as taking air in, the lungs keep unwanted material out of the body. The air is full of small particles and bacteria and the average person inhales nearly one million bacteria per day. However, because the lungs are so effective at getting rid of bacteria, it is rare for people to develop chest infections.

Your airways are lined by a layer of sticky mucus (called sputum when it is coughed up) that traps particles and bacteria, helping to keep the airways moist and clean.

This mucus is constantly being pushed upwards towards the throat so that it can be either coughed up or swallowed. The pushing is done by tiny hairs called cilia which "flick" the mucus upwards. This is the main way that the air passages are kept clean and free of infection.

What is bronchiectasis?

In bronchiectasis, parts of the lung tubes (airways) become damaged and wider than normal. These wider areas are less effective at clearing mucus (sputum) from the lungs and so mucus gathers and may become infected with bacteria.

Chest infections may happen when bacteria grow and the body is not able to clear the lungs because of the damage, or because the mucus is too thick.

Bronchiectasis can affect one, or several parts of the lung. It can be quite mild, where there is not a lot of mucus or can be more severe where people might cough up more mucus.

Infections can cause the lungs to become inflamed, which can damage or block parts of the lung. This can lead to symptoms like coughing up mucus, frequent chest infections, breathlessness, chest pain and tiredness.

Why have I developed it?

The lung damage and widening of the lung tubes (airways) can be caused by many different conditions. In some cases, a bad infection such as pneumonia or childhood whooping cough can cause the damage, and the condition is referred to as "post-infective" bronchiectasis. Other conditions commonly linked with bronchiectasis are:

  • Problems with the immune system.
  • Severe asthma complicated by an allergic reaction to a fungus called Aspergillus (called allergic bronchopulmonary aspergillosis or ABPA).
  • Conditions where the immune system attacks the body, like rheumatoid arthritis or ulcerative colitis.
  • An obstruction or blockage of the airways after inhaling something.
  • Inherited problems where the lungs do not develop normally (primary ciliary dyskinesia or PCD).
  • Alpha-1 antitrypsin deficiency
  • Infection with tuberculosis (TB) or bacteria that are similar to TB (called non-tuberculous Mycobacteria or NTM)
  • Chronic obstructive pulmonary disease (COPD)

Your doctor will ask you some questions and may perform some tests to find out why you have developed bronchiectasis (see section below). Often the cause is not found (idiopathic). This does not mean that there is no cause, only that medical science does not understand enough about the disease to know what the cause is yet.

In most cases, the treatment of bronchiectasis is the same regardless of the cause. There are, however, a few causes where special treatments are required. See Treatment.

How is it diagnosed?

Bronchiectasis is suspected in people with any of the common symptoms of the disease, like persistent cough, mucus (sputum) production or frequent chest infections.

These symptoms can overlap with the symptoms of other chest conditions like COPD or asthma, so it is common for people to have the tests for these conditions first, before bronchiectasis is suspected.

If your local doctor or hospital doctor suspects bronchiectasis, they will perform some additional tests:

What are the symptoms?

Every person's experience is different, so it is not possible to describe a typical person with bronchiectasis. You may have some or all of the following symptoms:

  • Cough - which may involve coughing up mucus (called sputum). Sputum is a very common symptom. The amount coughed up can vary a lot, as can the colour, which may be white, yellow, green, dark green or brown. The picture shows different sputum samples from bronchiectasis patients varying in colour from clear to dark green/brown).

  • Breathlessness - caused by the damaged airways working less well. In many cases, breathlessness is not a problem, but sometimes people may notice they are out of breath walking up hills or stairs. In severe cases, people may get breathless during less strenuous exercise.
  • Feeling very tired (fatigue) - the body uses a lot of energy to fight infections, as well as in coughing and in breathing. This can be made worse if people have trouble sleeping because of other symptoms.
  • Chest discomfort - this can be felt as a pain, a tightness or a feeling of fullness in the chest.
  • Frequent chest infections - people may feel that they easily pick up infections and that they more quickly affect their chest. The symptoms of cough, breathlessness, wheezing, chest discomfort and tiredness may get worse during an infection. Healthcare professionals often call chest infections "exacerbations" to show that not all flare ups of symptoms are caused by infection. See our FAQ on What is an exacerbation?

How severe is my condition?

If your bronchiectasis is well controlled, you should have few symptoms and be able to lead a normal life. This is the goal of treatment, wherever possible.

When bronchiectasis symptoms start to interfere with daily activities, this is a sign that your bronchiectasis is more severe. Bronchiectasis is a complicated condition and there is not one single test or sign that will tell you whether your condition is mild, moderate or severe.

Factors known to be linked with more problems are:

  • Breathlessness: If you are unable to walk 100 metres without stopping, this is a sign of more severe bronchiectasis.
  • Chest infections: having three or more chest infections in a year.
  • Regularly growing bacteria on mucus (sputum) samples: this suggests your lungs have some regular infection within them which can be a sign that the condition is more severe, particularly if a bug called Pseudomonas is regularly found.
  • CT scan: your doctor will check your CT (computed tomography) scan. A CT scan uses X-rays to make detailed pictures of parts of your body. If the bronchiectasis affects both lungs, or several parts of the lung, it may be worse than if it only affects a small part of the lung.
  • Hospital admissions: if you have been admitted to hospital with bad chest infections, or because you needed injection antibiotics, it is likely that your bronchiectasis is more severe. See section on antibiotics.
  • Weight: if having bronchiectasis causes you to lose weight so that you become underweight, this suggests it is more severe.
  • Lung function tests: your doctor may ask you to do some breathing tests (called spirometry) to find out your lung capacity. This shows how well you can breathe by measuring the amount of air in your lungs and how fast you can breathe out. Lower lung capacity suggests your bronchiectasis is more severe.
  • Age: has an important impact on symptoms and severity of bronchiectasis, because the lungs naturally get smaller as you get older, and the immune system becomes less effective.

These are only a guide and some people may have several of these and still live a normal life, while some people may have none of the above, but may have other important factors that impact upon their quality of life.

Many of these factors can be improved with effective treatment. Even if your bronchiectasis is considered to be severe, it can be greatly improved with treatment.

How long will I live?

For patients with mild/well controlled bronchiectasis there should be no difference in life expectancy than the population as a whole. For patients with severe/uncontrolled bronchiectasis or with additional risk factors the importance of good control is very important as there may be an impact on life expectancy.

To learn more about how to control your bronchiectasis go to Managing my bronchiectasis.

Do also discuss your own condition with your consultant or doctor if you want to know more.

Advanced information on bronchiectasis from ERS

In-depth medical information​

You can find more in-depth medical information about bronchiectasis in the European Respiratory Society publications below.

This information is designed for healthcare professionals but will be of interest to some individuals in search of more advanced information.

Please note that some of the links below contain detailed and complex information and survival rates.

Videos (advanced technical)

Duration: Six videos (5 min each) of medical experts in conversation on a range of topics concerning antibiotics, inflammation, Pseudomonas,, acute exacerbations and NTM. Please note these videos are aimed at healthcare professionals but some patients may also find them useful.

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