Many people with aspergillosis also develop bronchiectasis, a condition in which some of the airways in the lungs become permanently widened and damaged. Understanding bronchiectasis can help explain many symptoms experienced by patients with Allergic Bronchopulmonary Aspergillosis (ABPA – Allergic Bronchopulmonary Aspergillosis) and Chronic Pulmonary Aspergillosis (CPA – Chronic Pulmonary Aspergillosis).

Although bronchiectasis cannot usually be reversed, it can often be managed effectively, and understanding how it works helps patients recognise symptoms and flare-ups early.

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The airways of the lungs

Your lungs contain a branching network of tubes called bronchi and bronchioles that carry air in and out of the lungs.

Air travels through the trachea (windpipe) into the bronchi, which then divide repeatedly into smaller and smaller tubes called bronchioles. At the ends of the bronchioles are millions of tiny air sacs called alveoli, where oxygen moves into the bloodstream.

The lining of the airways produces a thin layer of mucus that traps dust, bacteria and fungal spores that we breathe in every day.

Tiny hair-like structures called cilia move this mucus upward toward the throat, where it can be swallowed or coughed out. This system acts like a self-cleaning escalator, helping keep the lungs clear.

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What is bronchiectasis?

In bronchiectasis, some of the airways become permanently widened and damaged.

When this happens:

• the airway walls become inflamed and weakened

• the tubes widen and lose their normal shape

• mucus becomes harder to clear

• bacteria and fungi can grow in trapped mucus

Over time, this leads to repeated infections and inflammation.

Doctors often describe bronchiectasis as a vicious cycle:

1. Infection or inflammation damages the airway

2. The airway widens and mucus clearance becomes poor

3. Mucus builds up in the airway

4. Bacteria and fungi grow in the mucus

5. Infection and inflammation occur again

Without treatment, this cycle can gradually worsen airway damage.

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Why bronchiectasis is common in aspergillosis

Bronchiectasis is particularly common in patients with aspergillosis, especially in ABPA.

In ABPA, the immune system reacts strongly to Aspergillus spores in the airways. This causes:

• allergic inflammation in the bronchi

• thick mucus plugs

• repeated airway irritation

Over time, this inflammation can damage the airway walls and lead to bronchiectasis, often affecting the central airways of the lungs.

Once bronchiectasis develops, mucus becomes harder to clear, which can allow bacteria and fungi such as Aspergillus to persist in the lungs.

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Symptoms of bronchiectasis

Many symptoms of bronchiectasis overlap with those of aspergillosis.

Common symptoms include:

• persistent cough

• regular sputum (phlegm) production

• breathlessness

• fatigue

• frequent chest infections

Sputum may be:

• clear

• yellow or green

• occasionally blood-streaked

In people with ABPA, patients sometimes cough up thick mucus plugs, which may appear brown or rubbery.

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How bronchiectasis is diagnosed

Bronchiectasis is usually diagnosed using a High Resolution CT (HRCT) scan of the lungs.

On a CT scan, doctors may see:

• widened airways

• thickened airway walls

• mucus plugs

• airways extending closer to the edge of the lung than normal

Radiologists sometimes describe a typical appearance called the “signet ring sign”, where the widened airway appears larger than the nearby blood vessel.

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Bronchiectasis and aspergillosis flare-ups

Because bronchiectasis and aspergillosis affect the same airways, it can sometimes be difficult for patients to recognise whether worsening symptoms are caused by:

• a bronchiectasis infection, or

• an aspergillosis flare-up.

Understanding the differences can help patients recognise when to seek medical advice.

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Bronchiectasis exacerbations

Bronchiectasis flare-ups are usually caused by bacterial infection in trapped mucus.

Patients may notice:

• increased sputum production

• sputum becoming yellow or green

• increased coughing

• fever or feeling unwell

• breathlessness

Many patients describe bronchiectasis exacerbations as feeling like a chest infection.

Treatment usually involves:

• antibiotics

• airway clearance physiotherapy

• increased mucus clearance

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Aspergillosis flare-ups

Aspergillosis flare-ups are usually caused by fungal activity or immune reactions to Aspergillus.

Patients may notice:

• worsening wheezing

• chest tightness

• increased breathlessness

• thick mucus plugs

Some patients cough up:

• brown mucus

• rubbery mucus plugs

• mucus shaped like small airway casts

In Chronic Pulmonary Aspergillosis, patients may also experience:

• persistent cough

• fatigue

• weight loss

• occasionally coughing blood

Treatment may involve:

• steroid treatment

• antifungal medication

• biologic therapies in ABPA

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Key differences patients often notice

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Both conditions can occur together

In reality, bronchiectasis and aspergillosis often interact with each other.

For example:

• ABPA can cause bronchiectasis

• bronchiectasis allows fungi and bacteria to remain in mucus

• infection and fungal inflammation can occur at the same time

Doctors may investigate flare-ups using:

• sputum cultures

• blood tests (for example IgE levels in ABPA)

• CT scans

• inflammatory markers

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Why airway clearance is important

Because bronchiectasis makes mucus harder to clear, airway clearance physiotherapy becomes a key part of treatment.

Common techniques include:

• Active Cycle of Breathing Technique (ACBT)

• Autogenic drainage

• oscillating devices such as Flutter or Acapella

Regular airway clearance helps:

• remove mucus from the lungs

• reduce infections

• improve breathing

• reduce cough

For patients with aspergillosis, clearing mucus may also help remove fungal material from the airways.

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When patients should seek medical advice

Patients should contact their healthcare team if they notice:

• rapidly increasing sputum

• fever or feeling unwell

• coughing blood

• severe breathlessness

• large mucus plugs

Early treatment can often prevent a mild flare-up from becoming a more serious infection.

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The key message

Bronchiectasis means that some airways in the lungs have become permanently widened, making mucus harder to clear.

However, many people with aspergillosis and bronchiectasis live active lives with stable lung function.

With good treatment, airway clearance, and early management of infections, bronchiectasis can often be well controlled for many years.

Path: Start » Complications » Bronchiectasis in Aspergillosis Patients