Bronchiectasis is irreversible central bronchial widening, usually accompanied by chronic infection and associated with varied conditions that can be present at birth or are hereditary in origin. The condition may involve one section of a lung, several lobes of a lung, an entire lung, or both lungs.

Bronchiectasis that is congenital is rare. If it does occur, the cause is usually the incomplete development of the outer part of the lung resulting in malformation of the developing bronchi. Acquired bronchiectasis results from destruction of the bronchial wall secondary to: infection, inhalation of harmful chemicals, immune related reactions, and insufficient blood supply to the bronchi. Acquired etiology may also be due to mechanical alterations, e.g., those alterations secondary to atelectasis or loss of parenchymal volume which are accompanied by increased traction on the walls of airways leading to bronchial widening and consequent infections.

The most common conditions that lead to bronchiectasis are severe pneumonia, necrotizing lung infections, bronchial obstructions, chronic fibrosing (causing scar tissue), lung diseases, and immunological deficiencies, e.g., acquired immunodeficiency syndrome (AIDS) which increase the susceptibility to infection.

Chronic cough and sputum production are the most common symptoms; however, occasionally, a patient is asymptomatic. The symptoms usually begin subtly, after a respiratory infection, and have a tendency to worsen gradually over the span of years. Generally, the condition begins with severe pneumonia that does not completely clear, causing persistent cough and sputum production. With progression of the disease, the cough becomes more productive. Hemoptysis may occur from the wearing away of the capillaries, but sometimes it may come from the connecting channels between the bronchial and pulmonary arterial systems. Coughing up blood occurs frequently and may be the initial and only complaint. In addition, wheezing, shortness of breath, and cor pulmonale may occur in progressive cases with associated chronic bronchitis and emphysema. Constant crackles over any part of the lungs, decreased breath sounds, prolonged expiration, and wheezing have the tendency to be more pronounced in smokers. Finger clubbing may occur with advanced disease and chronic infections are continuous.

In general, chest x-ray and high resolution computed tomography (CT) scans of the chest are indicated. In addition, sputum cultures, bronchial washings, and serological studies for evidence of fungus, and biopsy of tissues may be indicated. Moreover, in cases that are of new onset, bronchoscopy may be done to rule out a tumor or other foreign body.

The aim of treatment is to combat infections; lessen secretions; minimize airway obstruction and complications, e.g., hemoptysis, hypoxemia, respiratory failure, and cor pulmonale. Treatment of infection usually includes use of antibiotic and bronchodilator medications, as well as physical therapy to promote draining from the bronchioles. Antibiotics may be indicated for extended periods for extensive or recurrent infections. For bronchopneumonia or complicated respiratory infections, intravenous (IV) antibiotics may be indicated. If cultures for the tuberculosis (TB) organism are positive, antituberculosis drugs are administered. Patients with bronchiectasis should not smoke cigarettes and should avoid other irritants. In addition, they should avoid medications that calm or sedate (sedatives), or medications that prevent cough (antitussives). Positioning to promote drainage (postural drainage), clapping, and vibration to the chest wall and back may also be helpful in promoting sputum clearance from the lungs. Chronic hypoxemia is treated with supplemental oxygen. Furthermore, lung transplant (usually both lungs) may be an option for patients with severe cystic fibrosis and bronchiectasis.

If infection recurs frequently in patients, long-term prophylactic antibiotic therapy may be indicated. Furthermore, influenza vaccine and pneumococcal vaccines are also considered helpful as prophylactic treatments. Finally, as the disease advances, more severe conditions may develop including, hypoxemia which leads to cor pulmonale, and pulmonary hypertension.

• May be entitled to special monthly compensation where the Veteran has a single service-connected disability rated as 100% with additional service-connected disability or disabilities independently ratable at 60% or more, which are separate and distinct from the 100% service-connected disability and involves different anatomical segments or bodily systems. See  38 CFR 3.350(i)(1) – Special Monthly Compensation (SMC).

• This disease, (condition), only in its active form , has a 3 year presumptive period and shall be granted service connection although not otherwise established as incurred in or aggravated by service if manifested to a compensable degree within the applicable time limits under38 CFR 3.307 following service in a period of war or following peacetime service on or after January 1, 1947, provided the rebuttable presumption provisions of 38 CFR 3.307 are also satisfied. [38 CFR 3.309 [Disease subject to presumptive service connection], 38 CFR 3.309(a). [chronic disease].

• An incapacitating episode is one that requires bedrest and treatment by a physician.

• Review special provisions regarding the evaluation of specific respiratory conditions under 38 CFR 4.96(a) - Rating co-existing respiratory conditions