Antibiotics
Antibiotics can play an important role in managing bronchiectasis, but they must be used carefully since they can cause side effects and contribute to antibiotic resistance. In people with BE, the total number of germs in the airways does not always increase as the disease progresses. Instead, the balance of organisms often changes where one or two can begin to dominate, driving inflammation and infection.

Before starting antibiotics, your doctor should test your sputum to see which bacteria and/or fungi are present in your lungs. This testing ensures the most effective antibiotic is prescribed and avoids unnecessary or ineffective treatments.

For patients who develop frequent bacterial infections despite consistent airway clearance, chronic antibiotic therapy may be recommended. This often involves using a nebulizer to inhale the antibiotics on a regular rotating schedule. The type of antibiotic and specific schedule depends on the bacteria being treated and you and your provider’s preferences.

Other Medications
In addition to antibiotic use, some people with BE may benefit from the use of other medications to help manage symptoms and support lung health.

• DPP-1 inhibitors – This new class of medication inhibits the dipeptidyl peptidase 1 (DPP-1) enzyme, which reduces inflammation in the lungs, thereby reducing the number of exacerbations. This medication works locally in the lungs, rather than throughout the body, helping to preserve overall immune system function.
• Bronchodilators – These medications open the airways and can help make breathing easier. This type of medication can help loosen mucus and make airway clearance treatments more comfortable and effective. Bronchodilators are also used when BE occurs alongside asthma or COPD, helping address those additional lung conditions.
• Corticosteroids – This type of medication may be used in BE if there are coexisting conditions such as asthma, COPD, or inflammatory bowel disease- associated BE that require steroid treatment. For people with bronchiectasis alone, steroids are usually avoided because they do not provide benefits, can cause side effects, and may make you more vulnerable to infections.
• Mucoactive agents (such as hypertonic saline): These agents help thin and loosen mucus. Some patients respond well to them, though results in research studies have been mixed. They may be appropriate for some patients.