There is currently no cure for bronchiectasis. Treatment for the condition mainly consists of using medication to break the cycle of infection and worsening lung damage. You will have an individual course of medicine that will be tailored to the characteristics of your bronchiectasis.
Other therapies (see below) are aimed at managing the symptoms of bronchiectasis, particularly the coughing and over-production of sputum (phlegm). However, these should only be tried after discussions with your GP, or healthcare professional.
In addition, you should consider the two points below.
Smoking makes the symptoms of bronchiectasis worse. Therefore, if you smoke, you should stop immediately if you are diagnosed with bronchiectasis. You should also try to avoid second hand smoke as much as possible.
You may need to be vaccinated against influenza (flu) and pneumonia. This will depend on your GP’s assessment of how at risk you are from these infections.
Your GP will prescribe courses of medication to you as and when they are necessary. This will depend on the symptoms that you are experiencing and the frequency and severity of your infections. The most common medicines used are:
- antibiotics, and
Antibiotics are widely used to target the bacteria responsible for the recurrent chest infections which are a predominant symptom of bronchiectasis. By limiting the amount of infections, and lessening their severity when they do occur, further damage to your lungs can be minimised.
Depending on the type of infections that you have, your GP will decide on your individual course of antibiotics. A sputum sample can be taken and tested to find out which bacteria are causing your infections and to identify any patterns of infection.
An antibiotic treatment regime can be created that is specific to your cycle of infections in order to limit their frequency and severity. Your GP should take sputum samples from you periodically to test for any changes in your infection cycle and the bacteria present.
Antibiotics can be taken in a number of different ways:
- orally (as a tablet that is swallowed),
- intravenously (a liquid injected into a vein),
- intramuscularly (a liquid injected into a muscle),
- subcutaneously (a liquid injected under the skin), or
- inhaled with a nebuliser (a device that converts liquid into mist so that it can be breathed in).
The length of time antibiotics are taken for can also vary. For example, you may be prescribed antibiotics for:
a short course of 7-10 days, or 10-14 days - to treat the symptoms of an infection, and reduce the amount of sputum in your airways, or
a longer course, possible daily, or for several weeks - to prevent an infection occurring and to maintain low levels of sputum.
If your symptoms do not respond to the antibiotics after two weeks, your GP may change your antibiotics to a different type. The type of antibiotics you take should also be changed regularly to prevent the bacteria developing a resistance to them.
Bacteria can adapt and ?nd ways to survive the effects of an antibiotic. They become ‘antibiotic resistant’ so that the antibiotic no longer works. The more often an antibiotic is used, the more likely bacteria will become resistant to it. For this reason, GPs will only prescribe you antibiotics when they believe it is necessary, and may vary your prescriptions with slightly different antibiotics.
GPs follow guidance from the National Institute of Clinical Excellence (NICE) about when and how often to prescribe antibiotics. If your GP believes that antibiotics will make little difference to your symptoms, they may not be prescribed at all. If your symptoms do not improve, or they get worse, your GP may prescribe antibiotics. If there is a possibility of further complications with your infection, antibiotics will usually be prescribed immediately.
Your GP will explain their decision to you and you should discuss any concerns that you have.
Corticosteroids may be prescribed by your GP as they act directly on your immune system, helping to calm the swelling and inflammation of your airways. They are sometimes prescribed as tablets that are swallowed, or as an inhaler which you breathe in (your GP will show you how to use this). Corticosteroids are routinely prescribed for other conditions, such as sinusitis and chronic asthma, but their use for bronchiectasis still needs more research.
Some studies have shown positive results for the use of inhaled corticosteroids in reducing the amount of daily sputum produced, easing coughing and improving lung function. However, one trial of people with chronic obstructive pulmonary disease (COPD) found that the incidence of pneumonia increased with the use of inhaled corticosteroids. Your GP will advise you about the possible benefits of corticosteroids and whether they will be suitable for you.
Depending on the severity of your symptoms and what you find most helpful, your GP, or healthcare professional, could advise you about some of the following. However, these will not be suitable for everyone and should only be used with medical advice.
If you are producing a lot of sputum, and antibiotics are not helping to reduce it, you may benefit from chest physiotherapy. The aim is to help clear the sputum from your lungs as soon as it forms, so that there is less available for the bacteria to infect. Your GP may refer you to a physiotherapist who can advise you about the best methods.
Physiotherapy involves exercising your arms and legs to help strengthen your chest muscles to improve your breathing. A ‘head down’ position is often adopted with someone clapping on your chest and back to clear your lungs of mucus. This is usually done once, or twice, a day. This method requires a lot of time and effort but, if it is done regularly, it can be very effective. You should drink plenty of fluids during the exercises because this makes your sputum less sticky and easier to clear.
Gentle, daily exercise - for example, swimming or walking - can help to clear your lungs of mucus. The movement helps the mucus work its way up from your lungs, making it easier for you to breathe. If you find the positions recommended in physiotherapy hard to maintain, gentle exercise may be a suitable alternative for you.
Make sure that you stay hydrated during any exercise by drinking plenty of water and do not push yourself too hard.
Cycle breathing is a technique that is sometimes used alongside physiotherapy. The pattern of breathing that is used is likely to be specific to you but, could, for example, involve taking four deep, gentle breaths, a pause to relax, and then two deep breaths where you force the air out as you exhale. This is then followed by a pause during which you may cough to expel the loosened mucus or sputum.
Some people find this technique uncomfortable but, for others, it can be useful several times a day to help clear the airways.
Postural drainage uses vibrations to loosen the build up of mucus, making it easier to clear your airways by coughing it up. This is sometimes done using an inflatable vest that has air pulsing through it to apply pressure to your chest. This pressure loosens the mucus in your airways and encourages it to move up and out of your lungs. Other types of mechanical devices are also sometimes used.
Postural drainage can be time consuming as it may need to be done twice a day. It should not be attempted without proper guidance from a healthcare professional.
Salt solutions - known as hypertonic saline - can be used to reduce the amount of mucus in your lungs, or to make the mucus less sticky. The solution is inhaled using a nebuliser (a device that converts liquid into mist so that it can be breathed in). More research is still needed but initial tests suggest salt solutions can help improve lung function.
Sometimes, it may be possible to remove the part of your lung that is affected by bronchiectasis. Provided the condition is not present elsewhere in your lungs, surgery can be a highly effective treatment. However, unfortunately, surgery is rarely an option because bronchiectasis tends to be present in both lungs and can be extensively spread around your airways.
In very severe cases, a lung transplant might be considered, but this carries its own risks. For example, it is possible that the new lung could fail, or that the donor organ could be rejected. You will also need to take immunosuppressant medicines (medicines that lower your immunity) for the rest of your life in order to lower the risk of the donor organ being rejected. These will leave you more vulnerable to infections.