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Some patients with cough and sputum (phlegm) production have a condition called bronchiectasis.  Bronchiectasis is a chronic lung condition in which relatively large airways (bronchial tubes) in the lungs have been injured.  The cause of the injury often is not known, but in many cases it is related to a previous or childhood chest illness (such as pneumonia or whooping couhg).  The injury causes the involved airways to become permanently dilated (larger in diameter than normal).

The injury can be localised to limited parts of the lungs, or it can involve the lungs diffusely.  The airway injury in bronchiectasis can lead to:

o Trouble clearing sputum (phlegm) from the chest, and excessive amounts of phlegm
o Chronic or recurrent infection in the affected bronchial tubes
o Inflammation (a reaction to repeated or chronic irritation and infection) in the bronchial tubes, which can lead to further damage
o Trouble breathing because the damaged bronchial tubes do not function normally

Symptoms, which can vary greatly from patient to patient and also from day to day, can include:

o Cough
o Coughing up sputum (phlegm) from the chest, often in large amounts.  The phlegm may vary from clear to yellow or green even when patients are stable and feel as well as usual
o Breathlessness, especially during exercise
o Repeated lung infections

Exacerbations of bronchiectasis are episodes when the symptoms (cough, sputum production, and breathlessness) deteriorate beyond the normal daily variability and the patient needs to increase their usual inhaled treatment or take antibiotics or steroids to help the episodes resolve.  These episodes can be frequent and generally affect the patient’s health making them feel less well even when the episode is over.  In addition the more episodes that occur, the more likely that the lung disease itself will progress.

Deciding which extra treatment to give (antibiotics, steroids or both) can often be difficult by antibiotics are only required if a bacterial infection is present.  The simplest way to tell this is by looking at the colour of sputum:

o Samples that look like clearish mucus (colours 1 and 2) do not usually require antibiotics unless pneumonia is suspected
o Samples that are yellowish or green (colours 3, 4 and 5) usually mean that there is bacteria present and will generally clear with antibiotic treatment

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