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.

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.

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.

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.

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:

• Common first tests

  • Chest X-ray: bronchiectasis cannot usually be seen in an X-ray, but this helps to rule out other causes of chest symptoms.
  • Spirometry: this is a breathing test that involves blowing hard and fast into a machine and then emptying the lungs of air. This does not diagnose bronchiectasis, but is one way of measuring the amount of lung damage.
  • Sputum samples: your doctor or nurse may ask you to cough some sputum into a pot which can be sent to the laboratory for analysis. This can find bacteria in the lungs which will help decide the best antibiotic to use if you have a chest infection in the future.
  • Blood tests: this can help to check your general health

• Specialist tests

  These tests are usually done in a hospital clinic.

  • CT (computed tomography) scan: this test is needed to diagnose bronchiectasis. This is a special type of X-ray that can build up a very detailed picture of the lung tissue. Because it is an X-ray, there is a small amount of associated radiation, estimated to be about the same as 70 normal X-rays.
  • Tests of the immune system: your doctor might organise blood tests to check how your immune system works and to check for possible causes of bronchiectasis, such as a lack of antibodies that fight infection and severe allergies.
  • Breathing tests: spirometry as described above be performed along with other more detailed lung function tests.

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?

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.

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.

People with bronchiectasis may also have other medical problems and conditions such as:

• Rheumatoid arthritis or an immune system problem.
• Sinusitis can be caused by the same problems as bronchiectasis.
• Conditions that have no relationship to the bronchiectasis.

These additional problems can have an impact on your quality of life. It is important to be aware that treatments for bronchiectasis might interact with treatments for other conditions causing side effects. If you are seeing a doctor or nurse for another condition, always make sure they know you have bronchiectasis and are aware of the treatments you are taking.

Some other conditions might make the symptoms of bronchiectasis worse. For example, inflammation of the nose (rhinosinusitis), symptoms of asthma, allergies, reflux from the stomach or problems with the immune system. Your doctor will treat these problems as well as treating your bronchiectasis to try and improve your condition.

• The difference between bronchiectasis, COPD and asthma

  Bronchiectasis, asthma and COPD (chronic obstructive pulmonary disorder) are 3 different conditions that are treated in slightly different ways. They can cause very similar symptoms and so there is sometimes confusion between them.

  It is possible for individuals to have two of these conditions or even all three.

  COPD is usually caused by cigarette smoking, whereas bronchiectasis and asthma are not caused by smoking. Asthma is a condition where the airways become inflamed, often associated with allergies.

  COPD and asthma are more common than bronchiectasis and are usually diagnosed based on the symptoms and lung tests. It is not possible to diagnose asthma or COPD on a CT scan.

• What is allergic bronchopulmonary aspergillosis?

  Bronchiectasis can be caused by a bad allergy to a fungus that is found everywhere in the environment called Aspergillus. The immune system responds in an overly aggressive way to this fungus, causing damage to the lungs and symptoms that are like an asthma attack. This is called allergic bronchopulmonary aspergillosis (ABPA for short). Individuals with this condition often have a history of asthma in the past.

  The treatment for this condition is to dampen down the immune system with steroid tablets. Sometimes, antifungal tablets (like antibiotics but that work specifically against fungi) are also added to help reduce the reliance on steroid tablets.

  If bronchiectasis has developed, the damage is often not reversible, and so after the ABPA has been successfully treated, you will need treatment for the bronchiectasis over the long term.

• What is NTM (non-tuberculous mycobacteria)?

  Non-tuberculous mycobacteria (NTM) refers to a group of bacteria from the same family as tuberculosis (TB) but which cause a different kind of infection than TB.

  NTM live in the environment and rarely cause any problems for people without lung disease. However, NTM can infect areas of the lung that have been damaged or infect people who have problems with their immune system. There are many different types of NTM causing many different types of disease.

  The typical symptoms of NTM infection in the lungs are cough, tiredness, weight loss, breathlessness, and sometimes chest pain or coughing up blood.

  NTM pulmonary disease can be a cause of bronchiectasis, where someone can pick up the bug and the bug causes damage to the lungs resulting in bronchiectasis. However, there is no agreement on this always being the case, and bronchiectasis may instead act as a cause of NTM pulmonary disease. It is also possible for NTM to infect the lungs in people that already have bronchiectasis, and this can cause symptoms to get worse.

  NTM do not damage the lungs in the way that TB does, and sometimes people live with NTM in the lungs without needing to take any extra treatment because the effects are quite mild. The treatment of NTM involves a prolonged course of antibiotics.

  There is very good information about NTM available at www.ntminfo.org including a brochure in 8 languages.

• What is Pseudomonas?

  Pseudomonas aeruginosa, or Pseudomonas, is a bacterium (or 'bug') that can cause infection in people with bronchiectasis. It affects about 1 in 5 of those with bronchiectasis at some point.

  It is found everywhere, in soil, water, on the skin of some people and in most man-made environments. It does not usually cause infection in healthy people, but it can infect damaged lungs such as those in bronchiectasis.

  If you catch Pseudomonas, your doctor may recommend a course of antibiotics to try to get rid of or to control it, or they may recommend that you take a different antibiotic when you get chest infections in the future.

  People with Pseudomonas can sometimes have more chest infections and more problems than other people with bronchiectasis because of its resistance to antibiotics, and sometimes it can damage the lung. Guidelines for doctors therefore suggest that people with Pseudomonas are monitored more regularly.

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.

• Guidelines

  • European Respiratory Society guidelines for the management of adult bronchiectasis (September 2017).
  • A version of the guidelines for people with experience of bronchiectasis and the public to help you understand what was recommended in the original guideline. Available in other languages at In your language.

  These guidelines were produced by a group of experts on the topic, which included healthcare professionals and people with personal experience of bronchiectasis from across Europe.

  
  

• Handbooks and Journals

  Handbooks
  
  

  • European Lung White Book
    Data to present a rigorous examination of lung health and disease in Europe.
    European Lung White Book - Bronchiectasis (chapter 15) - also available in Italian

  • ERS Monograph - Bronchiectasis (2011)
    Offers a comprehensive review from leading international experts. The chapters cover the epidemiology, aetiology and pathophysiology of this condition, define modern investigation algorithms and describe recent developments in treatment strategies. Accessible to ERS Members. Priced.

  
  Journals
  

  These journals contain articles on a wide range of bronchiectasis research. Search the resources below and see News for most recent articles.
  

  • European Respiratory Journal (ERJ)
    Search ERJ archive for article abstracts about bronchiectasisi.
  • European Respiratory Review (ERR)
    Search ERR archive for bronchiectasis articles.
  • Breathe
    Search Breathe archive for bronchiectasis information
    
  • ERJ Open Research
    Search ERJ Open Research for bronchiectasis articles.

• E-learning

  • Non-cystic bronchiectasis, Stefano Aliberti, MD (Module Director)