How Is Bronchiectasis Treated?

The goals of treatment are to:

• Treat any underlying conditions and respiratory infections
• Help remove mucus from your lungs
• Prevent complications

Early diagnosis and treatment of bronchiectasis are important. The sooner your doctor can start treating any underlying conditions that may be causing the bronchiectasis, the better the chances of preventing further damage to your lungs.

The mainstays of treatment for bronchiectasis are:

• Medications, especially antibiotics
• Chest physical therapy (CPT)

Medications

The main medicines used to treat bronchiectasis are:

• Antibiotics are the main treatment for the repeated respiratory infections that bronchiectasis causes. Doctors usually prescribe oral antibiotics to treat these infections. For hard-to-treat infections, you may be given antibiotics through a tube into a vein in your arm. Your doctor may be able to help you arrange for a home care provider to give you intravenous antibiotics at home.
• Bronchodilators open your airways by relaxing the muscles around them. Inhaled bronchodilators can be breathed in as a fine mist from a metered-dose inhaler (puffer) or a nebulizer (ne'-byu-lye"-zer). These medicines work quickly because the drug goes directly into your lungs. Doctors usually recommend that you use a bronchodilator right before you do your chest physical therapy.
• Corticosteroids help reduce inflammation in your lungs. They work best when you take them with an inhaler.
• Mucus thinners, such as acetylcysteine, loosen the mucus.
• Expectorants help loosen the mucus in your lungs. They often come in combination with decongestants, which may provide additional relief. You do not need a prescription for them.
• Saline nasal washes help control sinusitis.

Chest Physical Therapy

CPT is also called chest clapping or percussion. It involves pounding your chest and back over and over with your hands or a device to loosen the mucus from your lungs so that you can cough it up. You should do CPT for bronchiectasis three or four times each day.

CPT is often called postural drainage. This means that you sit or lie on your stomach with your head down while you do CPT. This lets gravity and force help drain the mucus from your lungs.

Some people find CPT difficult or uncomfortable to do. Several devices have been developed that may help with CPT. The devices include:

• An electric chest clapper, known as a mechanical percussor.
• A removable inflatable therapy vest that uses high-frequency air waves to force the mucus that is deep in your lungs toward the upper airways so you can cough it up.
• A "flutter" device, a small handheld device that you breathe out through. It causes vibrations that dislodge the mucus.
• A positive expiratory pressure mask that creates vibrations that help break the mucus loose from the airway walls.

Several breathing techniques may also help loosen some of the mucus so you can cough it up. These techniques include:

• Forced expiration technique (FET)—forcing out a couple of breaths or huffs and then doing relaxed breathing
• Active cycle breathing (ACB)—FET with deep breathing exercises that can loosen the mucus in your lungs

Depending on how serious your condition is, your doctor may also recommend:

• Oxygen therapy.
• Surgery to remove a section of your lung. Doctors usually do this only if other treatments have not helped and only one part of your lung is affected. If you have major bleeding, your doctor may recommend either surgery to remove the bleeding part of your lung or a procedure to control the bleeding.