The main symptom is recurrent chest infections, in which the patient develops a cough productive of green phlegm, and perhaps increased shortness of breath, fever, chest pains and malaise. In between infections, most patients will bring up some phlegm most days – small amounts of clear phlegm in milder cases, but patients with severe disease can produce large amounts of green and thick phlegm each day even when well. Patients with severe disease may also be short of breath when walking fast due to the underlying lung damage.
Bronchiectasis is usually diagnosed using a detailed X-ray of the lungs called a CT scan. A standard chest X ray is often normal or near normal in patients with bronchiectasis, and even when abnormal, the changes that are present may not be obviously due to bronchiectasis. Blood tests are required to test for some of the causes of bronchiectasis and it is also important to measure the lung size and function by a simple breathing test called spirometry.
Once bronchiectasis has developed, the damage cannot be reversed. However, in most patients, the disease either does not worsen or only slowly worsens with time, and the combination of regular physiotherapy to clear the chest and appropriate antibiotics control the symptoms reasonable well. It is vital that chest infections are treated quickly with effective antibiotics, eg. amoxicillin 500mg tds or coamoxiclav 625mg tds for at least 10 to 14 days. These prolonged courses of stronger antibiotics are important to prevent the chest infections recurring quickly. Some patients with frequent chest infections requiring antibiotics several times per year will need to start low dose antibiotics all the time to prevent infections. Characterising exactly what happens during an exacerbation of bronchiectasis and investigating the best long-term treatments are other areas of importance for research.
The need for fair access to new and precision medications is desperately needed for Bronchiectasis.