Bronchiectasis can be treated, and symptoms improved, but it cannot usually be cured. It is very important to also treat infections and inflammation associated with bronchiectasis. Treatment can improve quality of life and stabilize the disease or slow progression.
In many patients with bronchiectasis, progression can be slowed and sometimes prevented. The key is to slow the cycle of infection, airway inflammation, airway injury, and retained secretions—often through a multi-pronged approach. Because mucus retention promotes infection, airway hygiene is central to successful treatment. Mobilizing secretions through airway clearance reduces bacterial loads and may increase the effectiveness of antibiotics. Antibiotics are not used to treat bronchiectasis itself, rather they are used to treat infections that may cause or exacerbate bronchiectasis. Airway clearance is recommended as an integral part of most treatment regimes. It is often helpful as an ongoing treatment to reduce the number of infections and the frequency of antibiotic use.
- Antibiotics can be taken by mouth or intravenously to treat infections that may cause bronchiectasis or make it worsen. Some antibiotics can be inhaled using a hand-held device called a nebulizer, which turns a medicine into mist that can be breathed in.
- Macrolides are a type of antibiotic that kill certain types of bacteria as well as reduce inflammation in the airways. Examples are azithromycin and clarithromycin. They can be used over several to many months but can have significant side effects. Their use requires careful consideration because macrolides are a cornerstone of NTM treatment and using them alone may trigger resistance. Patients should consult with an expert who understands both bronchiectasis and nontuberculous mycobacteria (NTM) because macrolides are not recommended as a single drug therapy for patients with NTM or at risk for NTM.
- Mucus-thinning medications, known as mucolytics, given by nebulizer helps clear mucus from their lungs. These medicines thin mucus in the airways so it can be coughed up more easily.
- Mucoactive agents are a class of drugs that aid in the clearance of mucus from the upper and lower airways. Mucoactive drugs include expectorants, mucolytics, mucoregulators, and mucokinetics. Saline is a commonly used mucoactive agent.
- Inhaled corticosteroids can reduce inflammation in the airways. Patients should exercise caution and consult with their doctor about the benefits and risks of using inhaled corticosteroids (or systemic ones) because steroids may enable bacteria to grow.
- Bronchodilators are drugs that relax the muscles around the airways. Most bronchodilators are inhaled as a fine mist via an inhaler or a nebulizer. They work quickly because the medicine travels straight to the lungs. Their purpose is to help breathing, not to directly treat bronchiectasis.
Airway clearance devices and methods
- Devices such as a vest are wearable and use high frequency chest wall vibrations that shake the chest to help loosen mucus. These devices can be stationary or portable, and some can be worn while the patient is mobile. They are highly effective and covered by Medicare for bronchiectasis patients in the United States.
- A hand-held device using oscillating positive expiratory pressure (PEP) and vibrations to clear the airways may be suggested. Patients blow into a portable PEP device and the resistance combined with vibrations help loosen mucus so it can be coughed out.
- Intrapulmonary percussive ventilation (IPV) involves a pressurized aerosol machine that turns medications into a mist. The mist is then inhaled as the machine oscillates, which vibrates the chest and loosens mucus.
- Sinuses are part of the “one airway system” that includes both lungs and sinuses. Therefore, sinus clearance is often recommended. Mucus can travel from the sinuses to the lungs and from the lungs to the sinuses, so complete pulmonary hygiene includes care of both. Sinus washes with sterile saline and other medications are often suggested.
Chest physical therapy can clear the airways.
Chest physical therapy (chest physiotherapy) includes a variety of physical techniques for loosening mucus from the lungs so that it can be expelled.
- Postural drainage uses gravity to drain mucus from the lungs. Patients lie in a position with the head and chest facing down. Patients may lie on one side and then the other. This approach is often combined with chest percussion and/or vibration (with the devices described above).
- Chest percussion involves controlled clapping on the body to loosen mucus and clear the airways. This technique is generally performed by a respiratory therapist but can be performed by a trained family member.
- Controlled coughing, such as “huff coughing” is often used with chest percussion. This kind of coughing loosens mucus so that it can be expelled from the lungs. The breathing techniques of forced expiration technique (FET) and active cycle breathing (ACB) can also help expel mucus. With FET, the patient forces out several breaths then does relaxed breathing. ACB is FET but with deep breathing exercises.
- Exercise is another excellent way to help loosen and clear mucus from the airways through more forced breathing.
Oxygen therapy might be prescribed for patients with bronchiectasis needing supplemental oxygen.
Oxygen therapy can ease breathing and enhance quality of life by allowing patients to conduct activities of daily living. It also can improve sleep, mood, and mental alertness. Importantly it can reduce the risk of heart failure. Oxygen may be prescribed while exercising, sleeping or full time as determined by a physician.
Patients can use Pulse Oximetry to measure the oxygen level (saturation) in their blood. Physicians also may check oxygen levels during clinic visits and during a “6 minute walk test” (6MWT) to see how oxygen levels are when walking or under any other exertion.
Oxygen can be delivered in three ways:
- Compressed gas oxygen comes in steel or aluminum containers of different sizes for home use and traveling.
- Liquid oxygen changes into a breathable gas.
- Oxygen concentrators are electrical devices that remove nitrogen from the air to increase oxygen levels delivered to patients.
Surgery may be performed if no other treatments have helped and only one part of the airway is affected.
- If bronchiectasis is isolated to one area, surgery could reduce infections and spread of the disease.
- If major bleeding in the airway occurs, it might be necessary to perform surgery to remove part of the airway (for example, one lung) or to perform a procedure called embolization to control the bleeding.
Bronchoscopy can also be used to clear blockage in the airway.
A bronchoscope is a long thin tube with a light and camera at the end that is inserted either through the mouth or nose. It can be used to diagnose bronchiectasis and to remove objects from the airway, but it cannot cure bronchiectasis.
In very rare instances of severe bronchiectasis, a lung transplant might be required.