Bronchiectasis 101: Why permanently dilated airways drive recurrent exacerbations

Bronchiectasis is an airways disease affecting the bronchial tubes that conduct air through the lungs, according to Mark Sala, MD, director of the bronchiectasis program at Northwestern Medicine. On a CT scan, the defining feature is dilation — airways that are abnormally large. Because this is a chronic, structural change, the airways do not return to normal once damaged.

That dilation sets off a cascade of downstream problems: the airways collect mucus, become chronically inflamed, and are prone to infection. Patients are burdened by excessive, productive mucus production and frequent exacerbations, or flares, defined as symptom changes that prompt a conversation with their doctor about antibiotics and adjustments to their treatment plan.

Sala emphasized that the symptom burden extends well beyond cough: patients often experience significant shortness of breath, inflammation, and weight loss, along with recurrent infections. Because there is no cure, he tells patients plainly that once someone has bronchiectasis, they have it permanently — making it a chronic condition managed over a lifetime.