What happens in the airways in bronchiectasis?

The dilation (widening) and thickening of the bronchi seen in bronchiectasis is due to chronic inflammation, which is the body’s response to micro-organisms colonising the airways. This results in the destruction of the elastic and muscular tissue components of the bronchial walls.

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• Persistent or frequent  airway inflammation leads to swelling of the bronchial walls and increased mucus production.
• Inflammatory cells enter the airways and release inflammatory products which cause progressive destruction of the airways.
• Repeated and prolonged inflammation causing further bronchial damage results in increased mucus which is difficult to clear effectively.
• If mucus is not effectively cleared from the lungs it becomes stuck, this is called ‘mucus stagnation’ which can lead to bacterial colonisation and risk of repeated infections.

A vicious cycle (Diagram) of progressive and irreversible airway damage and recurrent infections.

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Initiating factors → Bacterial colonisation - Reduced mucociliary clearance - Ciliary damage → Exacerbations → Decline in health