Bronchiectasis is a chest disease. The airways in the lungs have become damaged and scarred. Once a person has bronchiectasis, they usually have it for life. Good treatment stops it getting worse and in very young children, can reverse some of the disease.
Key points to remember about bronchiectasis
- bronchiectasis (Bx) is a type of scarring in the lungs
- mucus (phlegm or sputum) can collect in the scarred area
- infections occur in this mucus
- the main symptoms of Bx are a wet sounding cough lasting for weeks or recurring frequently, and repeated chest infections
- once your child has Bx, they usually have it for life
- early recognition and treatment can improve the scarring
- good care can help your child to stay well with Bx
What is bronchiectasis?
You can't catch Bx or give Bx to anyone.
Bronchiectasis (Bx) is a chest disease - the airways in the lungs have become damaged and scarred.
The airways (or breathing tubes) become widened and mucus can be trapped in pockets within the airway. Having extra mucus in the airways means bacteria and viruses can grow quickly and cause new or long-lasting (chronic) infection.
These infections cause damage and more scarring to the airways and lungs. Once this has happened, the scarring is usually lifelong. But, with good treatment, there can be some improvement and further damage prevented. Good treatment is especially important in young children because their lungs are still growing.
Figure A shows a cross-section of the lungs with normal airways and with widened airways. Figure B shows a cross-section of a normal airway. Figure C shows a cross-section of an airway with bronchiectasis.
Bx is different from asthma but some children with Bx have asthma as well.
What causes bronchiectasis?
Most children get Bx after having a very bad chest infection or repeated chest infections. Bx usually develops after:
- a severe bronchiolitis or pneumonia requiring hospitalisation
- chest infections which need repeated antibiotic treatment at home
- a wet sounding cough which lasts for weeks or recurs frequently
Less common causes
Problems with fighting off infection. Some children cannot fight infection very well because they are born with a problem in their infection-fighting (immune) system.
Medications. Some medications (such as oral steroids) cause difficulty in fighting off infection.
Objects stuck in the airway. If a child breathes in a nut or a piece of a toy and this gets stuck in the airway, it can cause a blockage that can lead to scarring.
Food or liquid going into the lungs (aspiration). Children who sometimes cough or choke when feeding have problems controlling their swallow. Food can end up in their lungs. This can also happen if food refluxes from the stomach and ends up going into the lungs. Over time this can cause Bx.
Primary ciliary dyskinesia. In this condition, the tiny mucus-clearing hairs (cilia) in the lungs are not working properly.
How long does bronchiectasis last?
Once a person has Bx, they usually have it for life. Good treatment stops it getting worse and in very young children, can reverse some of the disease.
Who gets bronchiectasis in New Zealand?
- 1 in 3,000 children gets Bx
- 1 in 1,300 Māori children and 1 in 625 Pacifica children get Bx
- there is 1 new case of Bx in a New Zealand child every week
What are the signs and symptoms of bronchiectasis?
Children with Bx feel well most of the time.
A wet-sounding cough is the main symptom. This usually lasts for weeks. Extra mucus (phlegm or sputum) in the airways is the cause.
This cough can get worse during infections, first thing in the morning and during exercise. Remember though that playing sport is helpful for keeping well.
When should I seek help for my child with bronchiectasis?
When children with Bx become unwell, they cough more and the mucus can change colour from clear to yellow or dark green. The mucus can sometimes be smelly. They may lose their appetite and feel tired.
When to see a doctor
If your child has Bx, you should take them to see your family doctor when:
- they have a bad cold with a runny green nose
- they are coughing more than normal
- their cough becomes more wet sounding
- they have more mucus which is darker in colour and/or thicker and/or smells
- they are breathing faster than normal
- they have a fever
- they have pain in their chest
- they are tired and not eating or drinking as well as normal
When to see a doctor urgently
Your child is very sick and needs to see a doctor urgently if they:
- have a high fever which doesn't go down with paracetamol
- get suddenly more unwell
- cough up blood
When to dial 111
Dial 111 within New Zealand (use the appropriate emergency number in other countries) for urgent medical help if your child:
- is having difficulty talking because they are so short of breath
- has blue lips or tongue
- is coughing up a large amount of blood
What tests might my child with bronchiectasis need?
A chest x-ray is usually the first investigation but does not always show Bx damage very well. Your child will probably also need a chest CT scan.
Chest CT scans show Bx damage well. This image of a chest CT scan shows Bx damage in one lung.
Your health professional will collect some mucus from your child. They will test this for bacteria or viruses. If they find bacteria, they will use the results to give the right antibiotic to your child.
Your child will have some blood tests to show that they can fight off infection.
A doctor may use a special telescope (bronchoscope) to look into the lungs. This lets the doctor see the condition of the airways and take a sample of mucus.
Lung function test
Your child will breathe into a machine to measure how their lungs are working. It usually takes about 15 minutes.
Sometimes your child may need other tests such as a sweat test (to look for cystic fibrosis).
What is the treatment for bronchiectasis?
1. Chest physiotherapy
Your child will need chest physiotherapy once or twice a day. There are different ways to do chest physiotherapy - either with breathing and percussion or by using a physiotherapy breathing device (PEP, acapella, bubble). This is to clear the extra mucus from your child's lungs to keep your child well. The physiotherapist will show you the best method to use with your child. The type of chest physiotherapy changes with age.
2. Exercise and sport
Exercise will help your child - it doesn't matter if they cough.
Exercise or playing sport 3 to 4 times a week is helpful to clear the mucus and to develop your child's lungs. Any type of exercise is good, especially if it makes your child take deep breaths. It doesn't matter if your child coughs during exercise.
Your child will need antibiotics if they start to get sick or if they are coughing more. Children with Bx need a longer course of antibiotics (10 to 14 days). Most often, you can give your child antibiotics at home. Sometimes, if your child is very unwell, they may need antibiotics in hospital.
4. Asthma treatment
Some children with Bx may benefit from inhalers because they also have asthma.
5. Bx action plan
Children and young people with Bx can have an action plan. You and your doctor or another member of your child's health team can discuss this so that it's right for your child. It lists your child's daily treatment and steps to take if your child becomes unwell.
How can I keep my child with bronchiectasis well?
If you want to give up smoking call Quitline 0800 778 778 , see the Quit/Me Mutu website, or talk to your family doctor.
- regular physiotherapy to keep lungs clear of mucus
- regular exercise and sport
- a healthy balanced diet
- keeping away from any tobacco smoke, especially in a house or car
- a flu vaccine every year
- regular hospital clinic and family doctor reviews
What health appointments will my child with bronchiectasis need?
Your child will have regular reviews with the hospital team. The team can include lots of different health professionals. How often the reviews happen depends on how well your child is.
The review will include:
- height and weight measurement to check growth
- lung function test to measure how well the lungs are working
- a mucus sample to test for bacteria so your child can get the right antibiotics
- a cough suction if your child is young and can't cough up mucus
- a check on how you're going with physiotherapy techniques and whether they need changing
If a chest infection is severe or continues for a long time, your child will probably need to go to hospital for 10 to 14 days to have specialist treatment.
Antibiotics. Your child will have these directly into a vein through a 'drip'. Sometimes your child will have a special drip called a 'PICC line'. This is a long tube which lasts for longer than a 'drip' - it doesn't need replacing regularly.
Chest physiotherapy. A professional physiotherapist will do this twice a day.
Sometimes, your child will have extra testing just like they do at outpatients appointments such as:
- lung function testing
- mucus sampling
- chest x-ray