Bronchiectasis in Children
Bronchiectasis is a chronic lung condition in which the airways (called bronchi) become abnormally widened, scarred, and less efficient at clearing mucus. This leads to a buildup of mucus that can become infected, causing repeated chest infections and ongoing inflammation. If left untreated, this cycle can lead to further lung damage.
Although bronchiectasis is more common in adults, it is increasingly recognised in children. In children, early diagnosis and proper treatment can often halt – and in some cases reverse – the progression of the condition.
How the Lungs Are Affected
In a healthy lung, the airways are lined with tiny hairs (cilia) that help move mucus up and out. This mucus traps dust, germs, and other irritants. In bronchiectasis, the airway walls are damaged and weakened. They become flabby, dilated, and filled with sticky mucus that cannot be cleared properly, creating an environment prone to infection.
Causes of Bronchiectasis in Children
Bronchiectasis is caused by damage to the lungs. This may result from:
- Severe or repeated lung infections (e.g., pneumonia, whooping cough, measles)
- Immune system problems that make it harder to fight infections
- Chronic aspiration (food or liquid entering the lungs)
- Airway blockage due to an inhaled object or enlarged lymph nodes
- Genetic conditions such as:
- Cystic fibrosis
- Primary ciliary dyskinesia (PCD)
- Prematurity or congenital lung problems
- Reflux disease (GORD/GERD) with repeated aspiration
Symptoms of Bronchiectasis
The most common symptom is a chronic wet cough, which may persist even after antibiotics. Other signs include:
- Daily cough with phlegm (clear, yellow or green)
- Frequent chest infections
- Wheezing or crackling sounds on breathing
- Breathlessness or difficulty keeping up with physical activity
- Tiredness or fatigue
- Poor appetite or weight loss
- Clubbing (widening and rounding of the fingernails)
A child with suspected asthma that does not improve with treatment may actually have bronchiectasis, or both conditions together.
When to See a Doctor
You should speak to a respiratory paediatrician if your child has:
- A wet cough that lasts longer than 4 weeks
- Recurrent chest infections
- A persistent cough that returns quickly after antibiotics
Early referral to a paediatric respiratory specialist is recommended if symptoms suggest possible bronchiectasis.
How Is Bronchiectasis Diagnosed?
Diagnosis involves several steps:
- High-Resolution Chest CT Scan
This is the key test to confirm bronchiectasis. It provides detailed images of the lung airways and reveals any abnormal widening or damage. - Lung Function Tests
These assess how well your child’s lungs are working and whether there is any airway obstruction. - Sputum or Cough Swabs
These tests identify bacteria that may be causing infection and help guide antibiotic treatment. - Blood Tests
These may be used to check for immune deficiencies or inflammatory conditions. - Other Tests (as needed)
- Sweat test (for cystic fibrosis)
- Nasal brushings or biopsy (for PCD)
- Swallowing assessments (to check for aspiration)
Treatment of Bronchiectasis
The aim of treatment is to break the cycle of mucus build-up, infection, and inflammation, preventing further damage.
1. Airway Clearance Techniques
This is the mainstay of treatment. Chest physiotherapy helps to loosen and remove mucus from the lungs. Techniques may include:
- Percussion and postural drainage
- Use of devices such as PEP (Positive Expiratory Pressure) or Acapella
- Huff coughing exercises
- Regular aerobic exercise (e.g., swimming, running)
Your child may be referred to a specialist physiotherapist for a personalised plan.
2. Antibiotics
Used during flare-ups (exacerbations) or long-term in some cases. May be oral, intravenous, or inhaled depending on severity and bacteria.
3. Inhalers or Nebulisers
If your child also has asthma, bronchodilators or inhaled steroids may help reduce inflammation and wheeze.
4. Vaccinations
Ensure your child is up to date with:
- Annual flu vaccine
- Pneumococcal vaccine
- Routine vaccine
These reduce the risk of infections that can worsen bronchiectasis.
3. Avoiding Irritants
Avoid exposure to tobacco smoke or environmental pollutants, which can trigger flare-ups and worsen lung damage.
Long-Term Management
Bronchiectasis in children requires ongoing monitoring. This may include:
- Regular clinic reviews with a respiratory team
- Lung function testing
- Monitoring growth and development
- Periodic chest imaging (in select cases)
- Adjustments to airway clearance techniques
If managed well, many children with bronchiectasis can lead healthy, active lives and avoid hospitalisation.
Can Bronchiectasis Be Reversed?
In children, early treatment can sometimes reverse bronchiectasis, particularly if caught in its early stages. That’s why recognising a persistent cough and treating it seriously is so important.
What to Do During a Flare-Up (Exacerbation)
Signs of a flare-up may include:
- Coughing more than usual
- Change in mucus colour or amount
- Feeling more tired or breathless
- Fever or poor appetite
Your child may need antibiotics and extra airway clearance. Keep a record of symptoms to help track progress.
Key Takeaways for Parents
- A wet cough lasting more than 4 weeks should not be ignored.
- Chest physiotherapy is essential to keep the airways clear.
- With early diagnosis and appropriate treatment, many children experience significant improvement.
- Regular follow-up and teamwork between families, doctors and nurses are key to good outcome
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