Bronchiectasis

Symptoms

Cough with phlegm on most days of the year, recurrent infections and fatigue. Sometimes there is also shortness of breath or blood in the sputum.

How it is diagnosed

The diagnosis is made with a chest CT scan. It is also important to find out what caused the disease, because some causes have specific treatment: severe past infections, immune deficiencies, an allergic reaction to a fungus (ABPA), disorders of the cilia, and nontuberculous mycobacteria (NTM). The work-up also includes sputum cultures and lung function tests.

When needed, for example when a sputum sample cannot be obtained, when an unusual infection is suspected, or when infections keep recurring in the same area of the lung, bronchoscopy with lavage (BAL) is performed to identify the organism precisely.

The foundation: physiotherapy and airway clearance

Clearing mucus is the foundation of all treatment, and every other therapy builds on it. A respiratory physiotherapist teaches breathing techniques and the use of simple devices, and inhaled saline is sometimes added to help loosen mucus. Consistent daily practice may reduce infections and help you feel better.

Additional treatments

• Targeted antibiotics guided by cultures, during an infection
• For people with frequent infections: preventive treatment, such as long-term azithromycin (Azenil in Israel; Zithromax elsewhere) or inhaled antibiotics (mainly for chronic Pseudomonas infection)
• Vaccinations and physical activity
• Treating the underlying cause, when it is known

What's new

There has been real progress in recent years. Brensocatib (Brinsupri) is an oral tablet from a new drug class, DPP-1 inhibitors, that reduces airway inflammation and the number of exacerbations. It is the first drug approved specifically for non-cystic fibrosis bronchiectasis (in 2025, in the United States and in Europe), and further drugs with a similar approach are under investigation.

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