The persistent cough that masks the third most common respiratory disease (and almost no one knows about it)

Chus Algaba Páramo , 67, has had a cough all his life . He tells El Confidencial that his childhood was marked by colds and flu ; at age 3 he had his tonsils removed, and at 9 he suffered his first bout of pneumonia , which would be followed by three more during his youth.

Despite recurring respiratory problems, no one, neither primary care physicians nor specialists, had ever mentioned a term that would come to mind in her thirties : bronchiectasis . It took a hospital stay, specific tests, and a long string of symptoms before someone finally put a name to her condition, when she was already 35.

It is a highly prevalent chronic respiratory disease : although there is no specific registry, it is estimated that between 7,700 and 10,000 new cases are diagnosed each year in Spain. Yet, it remains virtually unknown.

Bronchiectasis —always plural—is an abnormal and irreversible dilation of the bronchial tree, the structure responsible for conducting air from the trachea to the pulmonary alveoli. This dilation can be localized or generalized and has serious consequences: mucus retention, recurrent infections, ongoing inflammation, and progressive deterioration of lung function.

Persistent cough, fatigue and strong emotional impact

Patients with bronchiectasis suffer from a variety of debilitating symptoms : persistent productive cough , fatigue, frequent respiratory infections, chest pain, dyspnea (shortness of breath), and even hemoptysis (bleeding when coughing).

Added to this is a severe impact on mental health. Anxiety, social isolation, and depression are common among those living with this chronic illness, often without a support network or clear diagnosis.

" Psychotherapy was essential for me," the patient says. "The constant fear of new infections, physical deterioration, uncertainty ... all of that ends up weighing on me." During the pandemic, episodes of dyspnea and restrictions further aggravated her anxiety. "Seeing myself vulnerable overwhelmed me, but thanks to psychological help and talking with other patients, I began to regain balance," she adds.

Although it affects thousands of people in Spain, bronchiectasis remains invisible. "It's the third most common chronic respiratory disease , behind asthma and COPD ," Miguel Ángel Martínez-García , head of the department at La Fe University Hospital in Valencia, tells this newspaper. "But it has no cure or approved treatment. And most doctors still don't consider it in their daily clinical practice," he explains.

The problem starts with the diagnosis . The symptoms are easily attributed to other, more well-known conditions: "They are very often confused with asthma or COPD. And meanwhile, the disease progresses silently." In some cases, a diagnosis can take up to 12 years.

Currently, the procedure to confirm the disease requires a computed tomography (CT) scan, a test performed only in hospital settings. Although the average diagnosis time has decreased , now around five years, it is still excessive. "It is essential that primary care physicians begin to suspect bronchiectasis in patients who do not respond well to treatments for asthma or COPD," argues Martínez-García.

The patient's testimony illustrates what thousands of patients experience in silence: "I was very active, but I started to get tired when climbing hills. I was short of breath, the cough wouldn't go away. No one knew what I had. Until, finally, they told me about bronchiectasis."

Since then, her treatment has included inhalers , nebulizers, respiratory physiotherapy, and psychotherapy sessions . "Antibiotics don't work for me because of my allergies. But physiotherapy gives me a lot of relief, and exercise is vital," she describes.

Thanks to the Spanish Federation of Associations of Allergy and Respiratory Disease Patients ( Fenaer ), she was able to help found a specific association for patients with bronchiectasis. "For the first time, I'm talking to people like me," she celebrates. "Information is power, and visibility changes everything," she adds.

Although bronchiectasis has no cure , proper treatment can significantly improve a patient's quality of life. The key lies in a multidisciplinary approach: pulmonologists, physical therapists, psychologists, nutritionists, and primary care physicians must work together.

The patient's daily life is marked by very strict routines: "As soon as I wake up, I use a bronchodilator, then I walk in the countryside, do nebulizers, disinfect the equipment, and then respiratory physiotherapy. I also practice yoga and continue to wear an FFP2 mask indoors ." Since moving from Madrid to a nearby town, she says she's improved her well-being: "I haven't relapsed in two years. The environment and the tranquility help."

The future: early diagnosis and research

The challenges for this disease are still enormous. "Years ago, it was called the orphan disease , and in part, it still is," acknowledges Dr. Martínez-García. "We need more training for professionals, more research, and specialized units that work in networks."

The patient sums it up clearly: "I demand systematic access to respiratory physiotherapy , mental health support, and nutritional counseling. But, above all, visibility. Because if it's detected early, its progression can be halted and years of unnecessary suffering avoided."