What symptoms might I get?

Cough

• It is usual for people who have bronchiectasis to have a chronic, productive cough. This means that you are likely to cough, and produce phlegm, on most days.
• This is not the case for everyone, and with the correct treatment, including good physiotherapy to clear your chest regularly, your cough should become less of a problem.
• Your cough is likely to change, for example if you have a chest infection. You may notice that you are coughing more often, producing more phlegm, or a change in colour of your phlegm, becoming more yellow or green. Over time you will become more aware of your 'normal' cough and phlegm and what changes signal that you need antibiotics.

Cough incontinence

• Urinary incontinence (bladder leakage) is common in patients with bronchiectasis. Although incontinence is not life-threatening, the impact on patients, families and carers may be profound and it is vital that people are given every opportunity to regain their continence.
• People who are referred into the continence service will be seen as an outpatient where a continence assessment and  a personalised treatment plan will be made based on treatments relating to:-

1.  general bladder health
2.  training in pelvic floor strengthening
3.  urge suppression techniques
4.  voiding techniques
5.  bladder re-training

The treatment you have will depend on the identified type of incontinence.

• A common identified bladder symptom is stress urinary incontinence and this is when urine leaks from the bladder due to a sudden extra pressure, for example when you cough. This occurs because the pelvic floor muscles and urethra cannot withstand the extra pressure and the pelvic floor muscles are weak. The amount of urine leaked can vary.

• Evidence suggests that pelvic floor muscle exercises are an effective treatment for stress urinary incontinence. These exercises are appropriate for all women except those who have had recent pelvic floor surgery.

• If you are experiencing any problems with your bladder then please discuss this with your Specialist Consultant who is used to helping people with this kind of problem and who can refer you for assessment and treatment to the appropriate specialist service.

Click here to see the role of the continence nurse

For other advice about Bladder care visit:
http://www.bladderandbowelfoundation.org/

Coughing blood (haemoptysis)

• Sometimes, coughing blood can be a symptom that people with bronchiectasis experience. Coughing blood can be frightening, and your doctor is likely to do some tests to find out why this has happened. This can occasionally be a sign of other lung conditions and should always be reported to your doctor.

• Coughing blood could be small amounts of fresh (red) or old (brown or rusty) blood mixed in with phlegm. For some people with bronchiectasis, this can happen when they have a chest infection and settles when they are given antibiotics.

• Occasionally coughing larger amounts of blood can be a problem. This can happen if some of the blood vessels in certain areas of the lungs become more likely to bleed. If you have coughed up blood, it is important to tell your doctor, and if it is larger amounts this needs to be treated quickly.

• If this is a problem for you then you may have a specific type of scan called pulmonary angiography to look at the blood vessels in the lungs. If there are vessels that can be seen to be the cause of the bleeding then this can be helped by a procedure called embolisation where the blood vessel(s) causing the trouble are blocked off. Occasionally surgery is used to remove the area of lung with abnormal vessels and bleeding.

Sputum (phlegm)

• Having a chronic cough and phlegm are symptoms of bronchiectasis. This could be described as ‘normal’ for people who have the condition. Some people however, have very little phlegm unless they have an infection, or may only produce phlegm first thing in the morning. Others produce large amounts of phlegm on a daily basis.
• Amount and colour of phlegm varies between individuals, and can also vary at different times of the day, or if you have a chest infection. Over time you will begin to learn what is ‘normal’ for you, and what changes in your phlegm signal that you have a chest infection.
• Changes can include an increase in amount of phlegm or a change in its colour, for example a darker green than usual, or a change from white to yellow. It all depends on the individual, and learning to recognise these signs is an important step in self-management.
• Clearing the phlegm from your chest is vital to keep your lungs as healthy as possible.

Microbiology (bugs)

The common bugs seen in Bronchiectasis are bugs generally known to be found in the upper airway of healthy people.

These include:

Haemophilus influenzae
Moraxella catarrhalis
Streptococcus pneumonia
Staphyloccus aureus

• We think these bugs land in everyone’s lungs all the time but in bronchiectasis instead of being swept out of the lungs by the tiny hairs they get trapped and start to cause infections. Rarer bugs are found from time to time and you should ask your doctor what these mean.
• One key point is that the above bugs often respond to common tablet antibiotics such as Amoxicillin or Doxycycline.
• As the mucus and the airway walls in bronchiectasis are thicker, the current national guidelines are that people with bronchiectasis should have 14 days (a fortnight) worth of antibiotics.
• One of the reasons we ask patients to give a sample when you are stable at clinic AND when you are having a flare up is to keep an eye on which bugs are in the lung. Most patients do “keep” the same bugs. The resistance against antibiotics can however change in the “same” bug from time to time, which may mean an antibiotic that has worked for you in the past may not work so well
• From time to time a new “visitor” bug can appear in the sputum. This might also mean you need different antibiotics to your usual. If we don’t keep an eye on your bugs through sputum samples the risk is that we use the wrong antibiotic and you remain poorly for longer.
• Pseudomonas is a bug often seen in patients needing specialist care in hospital clinics. Pseudomonas almost never responds to standard antibiotics and the only tablet antibiotic known to work against it is ciprofloxacin. If you have Pseudomonas long term then ciprofloxacin is the first choice treatment for flare ups. If you have Pseudomonas and don’t improve with ciprofloxacin tablets this may mean you need to have a course of intravenous antibiotics through a “drip”. 
• In patients with repeated infections we can try nebulised (mist delivered) antibiotics. Colistin (often called colomycin) and Gentamicin are two very different antibiotics that might reduce flare ups by keeping the bug numbers low. These treatments won’t make you feel suddenly better. When used in this way they are not treatments for a flare up but are long term treatment aiming to drop the number of infections you get in a year. One challenge is that these treatments do take time and effort  as the nebuliser can take over 10 minutes twice a day. Some patients struggle to keep taking them regularly.
• At present there are no licenced antibiotic inhalers for use in bronchiectasis. These are currently being tested in research trials so may be an option in the future.

Exacerbations (chest infections)

• Exacerbations or chest infections are common in bronchiectasis. Having repeated chest infections is often what leads people to seek their doctor’s advice before a diagnosis is made.
• Although people who have bronchiectasis may usually have a cough and phlegm that is ‘normal’ for them, from time to time these symptoms will change and could indicate the start of a chest infection.

Common signs of a chest infection include

Coughing more than usual
Change in colour or amount of phlegm
Feeing more breathless than usual
Having a high temperature
Feeling generally unwell
Occasionally, having pain in the chest

• Not all people will have all of these symptoms with a chest infection. Over time, you may start to recognise a pattern that tells you that you have a chest infection.
• Managing infections correctly and quickly is very important in bronchiectasis. You can find out more about what you should do if you think you have an infection here.

Breathlessness

• Breathlessness can be described in many ways. Some people call it feeling out of breath, feeling short of breath or having trouble catching their breath. Doctors often call breathlessness ‘dyspnoea’.
• Breathlessness can be a symptom of bronchiectasis, but not for everyone. Some people find they do not get breathless, whereas others may have some breathlessness even when they are well.
• Knowing what level of breathlessness is ‘normal’ for you will help you to recognise if this symptom gets worse.
• Some people find that feeling more breathless than usual can be a sign that they are developing a chest infection. Often this is as well as a change in amount or colour of phlegm.
• Breathlessness can also be a symptom of other illnesses, so it is important to discuss any changes in breathlessness with your doctor.

You can find out more about how to manage breathlessness here.

Fatigue

“But bronchiectasis does make you feel tired as well, it takes it out of you, you know.” Celia, 67

• If you have bronchiectasis and experience fatigue or extreme tiredness, you are not alone. We know that many people with bronchiectasis have fatigue. Unfortunately, we do not know the exact reasons why this happens.
• Fatigue can be a problem in many chronic diseases, including other diseases of the lungs, such as chronic obstructive pulmonary disease (often called COPD) and diseases involving other parts of the body, such as the liver.
• When we carried out some research into fatigue in bronchiectasis we found that people with more symptoms of breathlessness tended to have more problems with fatigue. People with low levels of lung function measured by breathing tests were also more likely to experience fatigue. Having fatigue doesn’t mean you have very severe bronchiectasis - it can be a symptom across all stages.
• People who have bronchiectasis often say that fatigue can be worse when they feel an exacerbation or infection coming on. If you have recognised this, you may have found that this is an early warning sign for you. If you think you may need antibiotics it is important to follow your self-management plan if you have one, or speak to your doctor or nurse.
• People who have periods of feeling extremely tired say they have to rest on those days if possible, and look forward to the days when they are not feeling so fatigued. Pacing yourself is very important. Looking after your body, managing your bronchiectasis and treating flare ups quickly is important. Doing this could help you to feel less tired.
• Pulmonary rehabilitation (a series of gentle exercises to improve body strength often supervised by a physiotherapist) is something you may wish to discuss with your doctors. It is recommended in the UK national guidelines for patients who have breathlessness when walking 100 yards or less on the flat. It can help people have a better quality of life.
• Remember, you are not alone in feeling like this, but you should always discuss any symptoms with your doctor, particularly any sudden change in fatigue. They will do any necessary tests and may be able to offer you help and advice.

Anxiety and Depression

"I try not to let it get me down, but obviously sometimes it does." Shirley, 67

"Some days it gets on top of me, and others I just say … pull yourself together, you are stronger than that, it’s just a bit of phlegm… and there are people that are worse off than me, so you just get on with it and accept it." Celia, 67

• Anxiety and depression can be a problem for anyone who is living with a chronic illness, and may vary depending on how the illness is affecting you at any one time.
• We know that people with bronchiectasis can experience anxiety and depression. You may be asked to fill in a questionnaire about this when you attend clinic. This way we can see if this is a problem for you, and help you to find ways to manage it.
• One trigger for anxiety can be the feeling of breathlessness. This can sometimes be quite frightening, and along with treating any medical cause such as a chest infection, you may find it helpful to develop ways to manage this feeling. You can find out more about managing breathlessness here.
• Sometimes, you may be asked if you would like to see a specialist nurse who may be able to help you with these feelings.
• The British Lung Foundation can also offer advice about coping with anxiety and depression. For more information visit www.blf.org