There is a particular kind of cough that gets waved through. It has been there for years, it is worse in the mornings, it always brings something up, and it has picked up a label along the way: a weak chest, a smoker’s chest, sinus trouble. Chest infections arrive two or three times a winter and clear with a five-day course of antibiotics. Nobody has ever scanned it.
For a good number of people in Ireland over 50, that cough has a proper name, and the name is bronchiectasis.
TL;DR
- Bronchiectasis is permanent widening of the airways that stops the lungs clearing mucus, producing a daily productive cough and repeated chest infections.
- It is routinely mistaken for COPD or asthma. A chest X-ray usually looks normal; a CT scan of the chest is the test that actually finds it.
- Prevalence climbs steeply with age, and roughly two-thirds of people diagnosed are women.
- The single most important treatment is not a medicine. It is daily airway clearance, taught properly by a respiratory physiotherapist.
- In Ireland it sits outside the HSE Chronic Disease Management Programme and off the Long-Term Illness Scheme list, so you often have to ask for care a person with COPD is offered automatically.
What bronchiectasis actually is
Healthy airways are lined with cilia, microscopic hairs that sweep mucus upwards and out. In bronchiectasis, repeated inflammation damages that lining and the airway walls stretch and slacken. Instead of narrowing, as they do in asthma, the airways widen abnormally and lose their escalator.
Mucus then pools where it should be moving. Pooled mucus is an excellent home for bacteria, the bacteria provoke more inflammation, and the inflammation causes more damage. That cycle is why the condition announces itself as repeated chest infections rather than one dramatic event. The damage is permanent, but the aim of treatment is to break the cycle, not repair the pipes, and that is a realistic goal at any age.
Why it gets missed after 50
Bronchiectasis hides behind better-known diagnoses. A daily productive cough and breathlessness in someone in their sixties reads as COPD; wheeze and a poor response to inhalers reads as awkward asthma. Both labels get applied, and the underlying condition carries on.
The imaging trap matters even more. A chest X-ray is normal in most people with bronchiectasis, so a clear X-ray is often taken as reassurance when it means very little. The diagnosis is made on a CT scan of the chest, and if nobody requests one, it is not made at all. The result is a diagnosis that frequently arrives years late.
Two patterns are worth knowing: prevalence rises steeply with age, and women make up between half and two-thirds of those diagnosed. A lifelong non-smoking woman in her seventies with a chesty cough is not an unusual patient. She is a typical one.
Where it comes from
Data from the European Bronchiectasis Registry found that previous lung infection and idiopathic disease together account for around 60% of cases. For many people in Ireland that infection is decades old: childhood pneumonia, whooping cough, measles, or tuberculosis in an era when TB was part of ordinary Irish life. Severe asthma and COPD are common contributors too, alongside immune deficiency, rheumatoid arthritis and inflammatory bowel disease.
One cause deserves particular attention here. Ireland has among the highest rates of alpha-1 antitrypsin deficiency in the world, with an estimated 3,000 people carrying the severe ZZ type. Bronchiectasis is explicitly on the list of conditions qualifying for free testing under the HSE-funded National Targeted Detection Programme at Beaumont Hospital, and it is a simple blood test your GP can arrange. If you have never been tested, raise it at your next appointment.
What good treatment looks like
Airway clearance comes first. The European Respiratory Society’s December 2025 guideline gives it a strong recommendation for most people with the condition, and it is a skill rather than a prescription. Techniques include the active cycle of breathing, autogenic drainage, postural drainage and positive expiratory pressure devices. A respiratory physiotherapist works out which combination suits your lungs, and it needs doing daily, not only when you feel unwell. Pulmonary rehabilitation is also strongly recommended where exercise capacity has dropped.
Flare-ups get treated properly. A 14-day antibiotic course is standard in bronchiectasis, particularly for severe flare-ups or where Pseudomonas aeruginosa is involved; the reflex five-day course that suits an ordinary chest infection is often not enough. Giving a sputum sample before antibiotics start is what allows the right antibiotic to be chosen next time.
Frequent flare-ups have specific options. For people with three or more exacerbations a year, long-term azithromycin is strongly recommended, as are long-term inhaled antibiotics for chronic Pseudomonas infection. The guideline is equally clear about what not to do: inhaled corticosteroids are not recommended routinely, and neither are long-term non-macrolide oral antibiotics.
Vaccination matters more than usual. Flu, COVID-19 and pneumococcal vaccines all count for more when your airways are compromised, and the RSV vaccine is recommended in Ireland for everyone aged 75 and over, and for those aged 60 to 74 with risk factors.
The Irish gap worth knowing about
This is the part that catches people out. The HSE’s Structured Chronic Disease Management Programme, which has supported more than 400,000 medical card and GP visit card holders since 2020 with twice-yearly reviews, covers four conditions: type 2 diabetes, asthma, COPD and cardiovascular disease. Bronchiectasis is not among them, and the integrated care hubs built under Enhanced Community Care are organised around the same COPD and asthma models of care.
It is also absent from the 16 conditions on the Long-Term Illness Scheme, a list that has not been added to since 1975. Cystic fibrosis is on it; bronchiectasis is not. For most people that means medicine costs fall under the Drugs Payment Scheme, capped at €80 per family per month.
None of this makes good care unavailable. It means you may have to ask for it by name.
Five things to do this week
- If you have had a daily productive cough for more than eight weeks, book a GP appointment, use the word bronchiectasis and ask whether a CT of the chest is warranted.
- If you already have the diagnosis, ask whether the underlying cause was ever investigated, including alpha-1 testing.
- Ask for a referral to a respiratory physiotherapist, and treat airway clearance as a daily habit.
- Keep a sputum pot at home and give a sample at the start of a flare-up, before antibiotics start.
- Check your vaccinations are current, and ask for a written plan you can act on quickly.
When not to wait
Contact your GP or out-of-hours service promptly if you cough up blood, if a flare-up brings fever, confusion or a rapid drop in what you can manage, or if breathlessness comes on suddenly or at rest. Coughing up a significant volume of blood is an emergency: call 999 or 112.
Bronchiectasis is a long-term condition, not a countdown. People who clear their airways daily, stay active and have a plan for flare-ups do well, often for decades. The hard part is the first step: getting the cough taken seriously rather than filed under getting older. At Críonna Health we keep coming back to the same point: a symptom you have lived with for twenty years still deserves a diagnosis.
This article is general information, not individual medical advice. If you are concerned about your breathing, speak to your GP, or contact HSE Live on 1800 700 700.
📷 Photo by Susanna Marsiglia on Unsplash
