Symptoms of Bronchiectasis

The Most Common Signs and Symptoms of Bronchiectasis

What are the common and uncommon signs and symptoms of bronchiectasis?

What is Brochiectasis?

Bronchiectasis is a form of chronic obstructive pulmonary disease (COPD) marked by an abnormal widening of the airways (the bronchi and the bronchioles) of the lung. It is often caused by chronic infections in childhood, yet, while many of these infections are now preventable with immunizations, the incidence of bronchiectasis is increasing.

When the airways become enlarged, extra mucus forms in them and pools in the widened areas, leading to infection. Airway obstruction also occurs due to damage to the cilia, the tiny protective hairs responsible for airway clearance. This results in a cycle of repeated inflammation, infection and airway obstruction characteristic of bronchiectasis.

Often developing gradually, symptoms of bronchiectasis may not appear for months or even years after the pre-disposing event or events. Symptoms and signs of bronciectasis may include:

1
Chronic Cough With Large Amounts of Thick, Foul-Smelling Sputum

woman coughing up sputum
What are the symptoms and signs of bronchiectasis?. Istockphoto.com/Stock Photo©mheim3011

A persistent cough (one lasting longer than eight weeks, and in some cases present for many years) is common. There are many possible causes of a chronic cough, and people diagnosed with bronchiectasis are often first "misdiagnosed" with one of these other causes.

The cough occurs daily, and is often accompanied by copious amounts of thick, purulent sputum. Sputum (or phlegm) consists of dead cells and other substances that are secreted by cells in the airways, and differs from saliva, which is secreted higher in mouth and airways. While overproduction of sputum is a hallmark of bronchiectasis, it may also occur with chronic bronchitis, smoking, or exposure to environmental pollution.

With the presence of infection, the mucus is often discolored, foul-smelling and may even contain blood.

2
Hemoptysis

People with bronchiectasis may sometimes cough up small amounts of blood. This term is referred to as hemoptysis. Hemoptysis (or coughing up blood) is due, primarily, to the rupturing of tiny blood vessels near the surface of bronchial tubes. Normally, this bleeding is minor, but occasionally requires emergent care. When hemoptysis does occur, it usually indicates further infection.

It's important to note that you should talk to your doctor even if you cough up a very small amount of blood. Coughing up even a teaspoon or two of blood is considered a medical emergency.

3
Dyspnea

Dyspnea, or shortness of breath, is another common symptom of bronchiectasis which occurs because of the blockage of the airways with mucus.

Typically, dyspnea worsens with exertion or exercise, at least early on with the disease. As the condition progresses, shortness of breath may occur even at rest.

Early on, dyspnea can be insidious, and many people first believe that they are simply out of shape or have gained  few pounds.

4
Weight Loss

Unintentional weight loss may occur with bronchiectasis because of the added caloric demand made by the body as a result of long-term, excessive coughing. There are other causes of unexplained weight loss as well, but this symptom should always be discussed with your doctor.

If you are living with bronchiectasis, read more about nutrition and COPD.

5
Fatigue

Fatigue is an overall feeling of tiredness or lack of energy. It is the type of exhaustion that can't be overcome easily with a good night of sleep or a cup of coffee.

In the case of bronchiectasis, one of the causes of fatigue may be lack of sleep caused by long-term excessive coughing. Sometimes, medication side effects can mimic fatigue and are common with antihistamines, blood pressure medicines, sleeping pills, steroids, or diuretics.

Check out these tips for fighting fatigue due to COPD.

6
Generalized Weakness

Weakness is a common symptom of many chronic illnesses. The weakness caused by bronchiectasis is basically generalized, meaning it affects the entire body, as opposed to localized weakness, which affects only a specific limb, muscle group, or one side of the body.

7
Clubbing of the Fingers

Clubbing of the nails can be a sign of long-term oxygen deprivation and may, or may not, be seen in bronchiectasis. Clubbing can occur with lung diseases such as idiopathic pulmonary fibrosis and COPD, but may be seen with other conditions ranging from digestive diseases, to Grave's disease (a type of hyperthyroidism) to cancers such as Hodgkin's disease, and is present in up to a third of people with lung cancer. It also occurs normally in a certain percent of the population as an inherited trait.

Clubbing first manifests itself as sponginess of the nail bed along with loss of the nail-bed's angle, causing the nail bed to curve downward resembling an upside down spoon.

8
Wheezing

Often described as a whistling sound heard during inhalation or exhalation, wheezing is caused by a narrowing or blockage of the airways. Oftentimes, wheezing can be so loud in people with bronchiectasis that you can hear it without the assistance of a stethoscope.

9
Repeated Lung Infections

Respiratory infections are common in bronchiectasis as part of an often vicious circle. Repeated infections can lead to bronchiectasis, but bronchiectasis also predipsoses a person to recurrent lung infections.

Infections which are common in people with bronchiectasis include bacterial infections (such as staphyloccus,) fungal infections (such as aspergillosis,) mycobacterial infections (such as tuberculosis,) or viral infections (such as influenza). If lung infections are treated immediately, bronchiectasis is less likely to occur.

10
Pain with Breathing

Pain with breathing or with a deep breath, also called "pleuritic chest pain," occurs in roughly half of people with bronchiectasis. Pleuritic chest pain or pleurisy may occur due to the condition itself, or due to complications such as pneumonia or even blood clots.

Sources:

Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.

Suarez-Cuartin, G., Chalmers, J., and O. Sibilia. Diagnostic Challenges of Bronchiectasis. Respiratory Medicine. 2016. 116:70-7.

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