Is Bronchiectasis COPD?

About bronchiectasis

Bronchiectasis, although uncommon, is increasing in prevalence (by approximately 9%) across the US and Europe.¹ According to research, it affects nearly 350,000 – 450,000 people in the United States, and about 212,000 people in the UK, and is more prevalent in women than men.^2,3

Symptoms 

Pathologically, bronchiectasis involves the widening of lung airways and a consequent increase in mucus buildup that can essentially become a breeding ground for bacteria and hence make the individual prone to infections .⁴ It can present with a breadth of symptoms that can evolve over a long period and these can become progressively worse. Predominantly, bronchiectasis is characteristic of cough and regular sputum (mucus) production, but other manifestations can include:⁵

1. Yellow/Green or bloody sputum
2. Shortness of breath 
3. Fatigue
4. Wheezy cough
5. Finger clubbing (enlargement/rounding of the skin on the tip of fingers and curving of nails)
6. Chest and joint pain

Causes and risk factors

Bronchiectasis can be congenital and occur because of malformations in the lungs of a foetus and thus primarily affects infants and children. It can also be acquired through another disease or condition, and this type is typically found in adults. 

According to the CHEST Foundation, there are two versions of bronchiectasis: cystic fibrosis (CF) bronchiectasis and non-CF bronchiectasis. There are various risk factors or diseases that contribute to non-CF bronchiectasis including:⁶

1. Lung infections 
2. Cystic Fibrosis  
3. Cilia function disorders 
4. Inflammatory bowel diseases 
5. Immune System Deficiency
6. Genetic Issues 
7. Asthma

It is interesting to note that a significant proportion of people diagnosed with bronchiectasis have ‘idiopathic bronchiectasis’, signifying that even though they have the disease they do not have any associated underlying condition.⁷

Is bronchiectasis contagious?

To holistically answer if bronchiectasis is contagious or not, its underlying mechanisms need to be scrutinised. As Master, Dr. Doctor Tran Thi Diem Trang explains in his article, congenital bronchiectasis due to improper lung development, is not contagious. However, it can be familial or hereditary and can therefore pass down in the family. Likewise, bronchiectasis because of exposure to toxic gases and/or chemicals or due to tumour formation is not contagious. However, if the driving force of the disease is bacterial, fungal, or viral infections, it can very well be contagious.⁸

Is bronchiectasis the same as COPD?

Chronic Obstructive Pulmonary Disease (COPD) is a term that encompasses chronic or long-term lung diseases predominantly including emphysema and chronic bronchitis. Emphysema occurs due to damage to the air sacs in the lungs (known as alveoli) which causes the lungs to lose their elasticity (or stretchability) and this causes breathlessness. Chronic bronchitis involves damage to the cilia (hair-like extensions in lung cells that help remove secretions and particles) and irritation of bronchial tubes (tubes that carry air from the windpipe to the lungs & vice-versa).⁹ Smoking forms one of the major driving factors behind the occurrence of COPD and this is where one can differentiate between the two diseases and understand that they are not the same. 

About COPD

Similarities between bronchiectasis and COPD

Both bronchiectasis and COPD patients present with similar symptoms: they present with long-term cough associated with mucus production and breathlessness, and therefore sometimes there can be a delay in treatment of bronchiectasis.¹⁰ 

Differences between bronchiectasis and COPD

Smoking (active or passive), and long-term exposure to air pollution, fumes, or chemicals are the predominant risk factors for COPD, whereas bronchiectasis stems from infections and immunodeficiency issues.¹¹ The most common pathogens (disease-causing organisms) found in the lungs of bronchiectasis patients include ​​Pseudomonas aeruginosa and Haemophilus influenzae.¹² These organisms can cause inflammatory reactions in the lungs leading to disease. Finally, another difference can be seen when looking at the age range that these diseases might occur in - researchers have indicated that COPD primarily occurs at advanced ages whereas bronchiectasis can occur at various ages. ¹⁰

Bronchiectasis treatment and management

The goal of bronchiectasis treatment is to prevent infections and flare-ups, and this is achieved by ensuring the removal of mucus from the lung airways and management of any underlying conditions (such as asthma, CF). Considering these aims, treatment is divided into a few subcategories:¹³

1. Antibiotics: This is the main treatment for combatting the frequent onset of lung infections brought about by bronchiectasis. Usually, they are given through the oral route. However, if the infection is persistent and difficult to manage, it can be given intravenously (IV) for better effectiveness
2. Mucoactive agents: Essentially this treatment focuses on using a class of medicines designed to break down and loosen the phlegm/mucus that is stuck in the lungs/airways due to infection. Once the phlegm is thinned, it becomes easier to remove when coughing
3. Bronchodilators: also known as inhalers or nebulizers, they can also be given in the form of tablets. They work by relaxing the lung muscles making it easier for the patient to breathe 
4. Corticosteroids: These are usually inhaled and work by reducing the inflammation in lung airways. They especially help if one has a wheezy cough
5. Chest Physical Therapy: This is a form of physiotherapy that involves the therapist clapping on the patient’s chest so as to help loosen the mucus and enable it to be expelled while coughing
6. Hydration: This is perhaps the easiest one to follow. Staying hydrated prevents the mucus from becoming viscous thereby making it easier to expel
7. Oxygen Therapy & Surgery: Used only in severe cases, oxygen therapy involves the placement of a face mask or insertion of tubes in the patient’s trachea, whereas surgery is undertaken in cases wherein there might be bleeding in the airways and hence the procedure may involve removal of one or part of the affected airway

Prognosis

Looking at the progression and outlook of the disease, it can be said that patients will be frequently affected by infections, but the treatments described above can help keep some of the infections at bay. It can also be concluded that most patients manage well in the long term.¹⁴ 

In the past few years, a bronchiectasis severity index (BSI) has been developed (note that this is still being tested and studied) that helps categorise patients according to severity and risk. The index uses several parameters which include clinical, radiological, and microbiological features to predict morbidity and mortality for non-CF bronchiectasis patients.¹⁵

An important aspect that controls the prognosis of the disease is the presence of Pseudomonas aeruginosa. Research indicates that approximately 25% of patients with non-CF bronchiectasis had the presence of this microorganism in their lungs. Furthermore, the pathogen also serves as one of the criteria in BSI and it has been found that patients with P. aeruginosa colonisation had more severe pathological changes in their lungs in addition to diminishing lung functions. In essence, patients with the presence of this bacteria have been shown to have a poor prognosis and a higher probability of mortality. ¹⁶

There is a range of support services available online that can help patients put their minds at ease. There is a support line and online community maintained by the British Lung Foundation. In addition, there are forums where patients can discuss their experiences and ask questions.^17,18

Summary

In summary, the succinct answer to the question ‘Is bronchiectasis the same as COPD’ is: No, it isn’t. But, leaving it at that would be a gross understatement and misrepresentation of the situation. As seen above, there are some areas in which the two diseases can overlap, and sometimes this might lead to late diagnosis or unfortunately, misdiagnosis. Hence, it is pertinent to keep in mind the cause of your symptoms. If they are from smoking or exposure to toxic materials, it is very likely to be COPD; whereas if they are from infections or are congenital, they are probably due to bronchiectasis. Regardless, it is best to have an appointment with your healthcare provider to have a clear understanding of your situation.