Bronchiectasis and COPD: Understanding Each Condition - Healthline

Bronchiectasis and chronic obstructive pulmonary disease (COPD) are two chronic conditions that involve damage to the lungs.

The causes and treatments for each differ. In some instances, COPD may cause bronchiectasis.

Read on to learn about the differences and similarities between bronchiectasis and COPD and how each condition is treated.

Bronchiectasis is a progressive lung condition caused by damage to bronchi (large air passages) in the lungs. With bronchiectasis, the walls of the bronchi become thickened from ongoing inflammation or infection.

People with this condition cough up large amounts of mucus, especially during flareups. Flareups of bronchiectasis are referred to as exacerbations. During an exacerbation, you will also find it harder to breathe.

Bronchi are designed to enable free breathing by letting air enter the lungs. Bronchiectasis occurs when the bronchi in the lungs become chronically inflamed and thickened. Over time, the thickening of the bronchial walls and subsequent scarring make it hard to move mucus out of the lungs. Recurring infections also become more likely.

Bronchiectasis occurs most often in people ages 75 and over. However, you can get this condition at any age. Having cystic fibrosis is a risk factor.

The underlying causes of bronchiectasis are not always known. However, this condition is often caused by other health conditions and infections that damage the lungs. These include:

People with bronchiectasis can live their usual lives, but exacerbation periods may be challenging. Diagnosis and treatment are essential for the best outcomes.

Chronic obstructive pulmonary disease (COPD) is an umbrella term for a group of progressive lung diseases that include chronic bronchitis and emphysema. People with COPD may have both of these conditions simultaneously.

COPD is a serious, chronic disease that progressively worsens over time. People over age 40 are at the highest risk, especially if they smoke. The use of tobacco products, such as cigarettes, is the most common cause of this condition.

COPD causes inflammation and thickening of bronchi in the lungs. It can also cause damage to lung tissue and the air sacs in the lungs. This results in difficulty breathing in oxygen, plus difficulty breathing out carbon dioxide. Carbon dioxide is a waste product of cells that are produced during respiration.

According to the American Lung Association, COPD can cause long-term disability and early death, especially if untreated.

People with COPD may have trouble breathing every day or almost every day. Flareups with more intense symptoms can also occur. COPD symptoms worsen over time and may eventually include:

• wheezing
• shortness of breath after mild exertion
• tightness in the chest
• chronic cough that may or may not produce mucus
• swollen legs and feet
• extreme fatigue

Bronchiectasis and COPD are not the same condition. However, they're both progressive lung diseases. Both conditions can make it hard to intake oxygen and release air from the lungs. Other shared symptoms include breathlessness, wheezing, and coughing.

Emphysema, a type of COPD, is different from bronchiectasis. For people with emphysema, damage occurs to the walls between air sacs in the lungs, making the walls less stretchy and less able to fill up with air. Bronchiectasis doesn't cause damage to air sacs.

Chronic bronchitis, another type of COPD, is also different from bronchiectasis. But, because it causes inflammation and narrowing of the bronchia, COPD is sometimes confused with bronchiectasis. Symptom overlap also causes people to confuse the two.

Bronchiectasis and COPD can occur together. This is referred to as bronchiectasis-chronic obstructive pulmonary disease overlap syndrome (BCOS). Some studies indicate that people with BCOS have poorer outcomes than people with only one condition.

One study found that people with BCOS had more incidents of acute respiratory distress than people who had COPD without bronchiectasis.

Since they're both chronic lung conditions, bronchiectasis and COPD have many symptoms in common. These include:

• chronic cough that produces mucus
• wheezing
• fatigue
• shortness of breath
• respiratory infections

While COPD and bronchiectasis are both chronic lung diseases that can make it difficult to breathe, they're different. Here are the main ways the two conditions are different:

Causes

The leading cause of COPD is smoking cigarettes. Exposure to secondhand or thirdhand cigarette smoke as well as exposure to pollution and poor air quality can also cause COPD.

Bronchiectasis is usually caused by other health conditions a person has.

Symptoms

There are a few different symptoms between the two.

Bronchiectasis can cause:

• clubbing (thickened skin under toenails or fingernails)
• hemoptysis (coughing up blood or a mucus-blood mixture)

COPD can cause:

Diagnosis

Another difference between COPD and bronchiectasis is how they're diagnosed.

COPD is a physiologic diagnosis.

• COPD is diagnosed based on an assessment of how your lungs actually function. COPD is diagnosed through a test called spirometry, which tests how well your lungs function by measuring airflow in and out of your lungs.

Bronchiectasis is a structural diagnosis.

• Bronchiectasis is diagnosed based on how your airway, specifically the tubes that lead into your lungs called bronchi, appears on images from a CT scan. In people who have bronchiectasis, the bronchi are dilated and thickened, which narrows the airway.

Treatment for bronchiectasis is designed to prevent lung infections and reduce or prevent exacerbations (flareups). These treatment options include:

• Antibiotics. Antibiotics are a common, first-line treatment. Usually, antibiotics are taken orally. If your symptoms are severe, your doctor may recommend intravenous antibiotics. These are given via injection.
• Mucus-thinning medications. Mucus-thinning medications may help reduce and remove mucus. You usually inhale these medications through a nebulizer. For some people, a decongestant may also help prevent or reduce congestion.

• Handheld airway clearance devices. Handheld airway clearance devices that you exhale into may also help break up mucus.
• Chest physiotherapy (chest physical therapy). These therapeutic techniques may be used to loosen mucus from the lungs. To do chest physiotherapy, a physical therapist will use certain techniques, such as clapping on your chest. Electronic chest clappers you can use at home are also available that mimic the hand motions used by physical therapists.
• Smoking cessation. If you smoke, your doctor will recommend ways that may help you quit smoking.

If you smoke, stopping will be an important part of COPD treatment. Smoking cessation can help slow the progression of your disease. Talk with your doctor about smoking cessation aids, so you can choose the best type for you.

Other treatment options for people with COPD may include:

Medications

Medications like inhaled bronchodilators and corticosteroids are commonly prescribed medications for COPD:

• bronchodilators widen the airways and relax lung muscles, making it easier to breathe
• corticosteroids reduce inflammation and swelling

Based on your symptoms and the severity of your disease, your doctor may prescribe a short-acting or long-acting bronchodilator for you to use. If your symptoms are severe, inhaled steroids you breathe in along with a bronchodilator may also be prescribed.

Oxygen therapy

If your blood oxygen levels are low, oxygen therapy may be used at home or in a medical setting. Oxygen therapy delivers oxygen to your respiratory system so you can breathe better. It may be delivered through a face mask or tube.

Pulmonary rehabilitation

A supervised pulmonary rehabilitation program will be recommended as part of treatment. Pulmonary rehabilitation may last for weeks or months. It's designed to teach you COPD management skills that will help you live a healthier life. These include:

Surgery

If your disease is severe and doesn't respond to medication, surgery may be an option. There are several types of surgery:

• Bullectomy. A bullectomy is done to remove large bullae (air spaces) caused by destroyed air sacs in the lungs.
• One-way endobronchial valve implantation. During one-way endobronchial valve implantation, a valve is inserted into a bronchial tube. The valve helps air leave the lung but not re-enter.
• Lung volume reduction surgery. During lung volume reduction surgery damaged lung tissue is removed.
• Lung transplant. In a lung transplant, a diseased lung is removed and replaced with a healthy one.

Bronchiectasis and chronic obstructive pulmonary disease (COPD) are two progressive lung diseases. Even though they share some symptoms, they're not the same condition.

The main cause of COPD is smoking cigarettes. Bronchiectasis is usually caused by other health conditions. Both conditions are chronic but can be treated with medication, lifestyle changes, and other strategies.