Bronchiectasis is a lung condition characterized by cough and sputum production in the presence of abnormal thickening and pocket formation of bronchial walls which is visible on special lung imaging.  The little pockets are similar in their mischief to the pockets that can occur in the wall of the colon:  diverticula.  In both scenarios the pockets can sometimes accrete enough bacteria that it leads to acute bronchitis in the lung and diverticulitis in the colon.   

In the bronchial tubes the pockets can sometimes provide a haven for a smoldering presence of what are referred to as atypical bacteria.  Most common in this regard is MAC, mycobacterium avium intracellular (a cousin of the TB germ).  Also seen are Nocardia, Aspergillus and Pseudomonas.  The presence of these “smolderers” leads to chronic inflammation which in turn leads to bronchial wall thickening.  The condition is best diagnosed by high resolution CT scanning.  The “high resolution” format allows sufficient magnification of the bronchi to see the changes. 

There are a variety of treatment options.  However, key to all of these is what is referred to as “good pulmonary toilet”, that is, taking measures to keep the bronchi open and pockets empty.  Using a nebulizer daily with either saline or a bronchodilator is very helpful.  Some patients benefit from an external device called the VEST which through vibrations to the chest wall helps clearance of sputum. Antibodies can be used either for acute exacerbations or on a regular on/off schedule each month. Identifying “atypicals” either through expectorated sputum cultures or via bronchoscopy is also of value. 

In the US 1.5% of women and 1.1% of men have bronchiectasis.  So, if an individual is experiencing a chronic cough, it is a diagnosis to consider. 

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