This is one of the not so uncommon diseases affecting the respiratory system. The disease is estimated to affect about 1 person in every 1000 persons in UK.
In this disease the elasticity of the bronchioles are lost making them wide and flabby also the mucosal drainage in the air passage is impaired leading to accumulation of respiratory secretions and increase episodes of lung infection. Frequent episodes of lung infections further damages the already damaged air ways.
Common presenting symptoms include cough with sputum which can be tinged with blood, shortness of breathing, pain in the chest etc.
Common causes of bronchiectasis include infections like tuberculosis, inhalation of foreign objects, congenital diseases like cystic fibrosis etc. However in many cases the underlying cause of bronchiectasis may not be identified.
There is no cure for bronchiectasis. Treatments of lung infections, breathing exercise, drainage of accumulated mucous etc are the available treatment modalities.

Causes
Bronchiectasis may occur due to two types of causes; acquired and congenital (causes present since birth).
Acquired causes are more common and include
1. Infections: the most commonly linked infections with bronchiectasis include tuberculosis, pneumonia caused by Staphylococcal, Klebsiella and Bordetella (the bacteria causing whooping cough) infections, fungal infections namely allergic bronchopulmonary aspergillosis
2. Aspiration of several toxic gases, fumes like ammonia etc
3. Accidental inhalation of foreign body
4. Long term alcohol intake
5. Heroin addiction

There are several clinical conditions which directly may not cause bronchiectasis but is commonly linked with bronchiectasis. These are
1. Childhood AIDS: This conditions makes the affected person susceptible to various opportunistic lung infections which otherwise do not occur in a person with normal immune system. These infections increase the chance of development of bronchiectasis later.
2. Inflammatory bowel diseases: in people suffering from inflammatory bowel disease allergic response may occur to inhaled fungal spores. This occurs due to altered response of the immune system towards various as such harmless foreign bodies.
3. Hiatus hernia: in patients suffering from hiatus hernia frequent backflow of food and acid from the stomach may lead to aspiration and subsequently bronchiectasis
4. Rheumatoid arthritis: people suffering from rheumatoid arthritis are also seen to be more susceptible to bronchiectasis although the link between the two diseases remains unexplored.

Congenital (present since birth) causes of bronchiectasis include conditions which affect the motility of the cilia (the fine projections responsible for various functions say for example in the airways these are responsible for removal of entry of foreign bodies, dust etc in the air passage) and transportation of ions across the cell membranes. These conditions include
1. Kartagener syndrome: in which the motility of the cilia all around the body is impaired.
2. Cystic fibrosis: in which the chloride ion transportation across the membranes are impaired leading to severe degree of localized bronchiectasis.
3. Young’s syndrome: in which repeated incidence of infections in the sinuses (the airspaces in the cheek bones, bones of the forehead etc) and air passages predispose the affected person to bronchiectasis.
4. Alpha 1 antitrypsin deficiency which commonly leads to emphysema may also be linked with bronchiectasis for reasons still unknown.
5. Certain rare primary immunodeficiency diseases like may increase the susceptibility to bronchiectasis.

Treatment
The goals of bronchiectasis treatment include control of underlying lung infections, facilitating removal of bronchial secretions, relief of airway obstructions, if any and prevention of complications.
Hence there are several treatment options recommended to achieve the goals; these are
1. Long term administration of antibiotic drugs to prevent as well as treat underlying lung infections
2. Facilitation of removal of accumulated fluids either by taking favorable posture (postural clearance) or by chest physiotherapy
3. Surgery might be required to remove the obstruction in the air passage which may lead to bronchiectasis in future. Sometimes excessive blood loss due to bronchiectasis amy also require surgical interventions.
4. Steroid inhalation (beclometasone dipropionate) may offer some benefit although doubts are

Prevention
Certain preventive steps can be taken to avoid the occurrence of bronchiectasis in future. These are
1. Vaccination of children against childhood infectious diseases like measles, whooping cough etc
2. Avoidance of toxic noxious and irritant gases which might harm the lung tissue
3. Adequate management of lung infections especially in children
4. Avoiding inhalation of foreign bodies in the air passage and seeking prompt medical help if accidental inhalation occurs.