Bronchiectasis (cont.)

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What is the treatment for bronchiectasis?

Bronchiectasis is not a curable disease. Instead, the goal of treatment is control of secretions and preventing infections. In some situations, where the disease is limited to one area of the lung, surgery may be a possibility to remove the area affected by the disease.

Basic lung hygiene is required for all patients with bronchiectasis:

  • Keep immunizations up to date to prevent infections.
  • Drink plenty of fluids to make mucous secretions less sticky.
  • Stop smoking and avoid secondhand smoke.
  • Get adequate nutrition by consuming necessary calories. For some people, breathing requires increased effort and thus and requires increased nutrition.

Chest physical therapy

The basis for bronchiectasis treatment is chest physical therapy to assist in coughing up secretions, and antibiotics to prevent infection.

Since the smooth muscles that surround the bronchial tubes are damaged, mechanical ways to clear secretions are used to increase air flow and decrease the risk of infection. Chest physical therapy uses percussion or clapping on the back to help loosen secretions and then changing positions of the body to allow gravity to help those secretions to be coughed up. Chest clapping may be done by a physical therapist, but family members can be taught to do this routinely at home. Mechanical devices such as chest clappers or vests also may be considered.

Antibiotics may be prescribed to treat an infection that occurs or they may be used as prophylaxis to prevent infection. The choice of antibiotics depend upon the clinical situation and may be guided by blood or sputum cultures that will try to identify the bacteria causing the infection, and the type of antibiotic that will effectively treat the infection. Many patients may be kept on a revolving course of different antibiotics over their lifetime. Inhaled antibiotics have been used in addition to medications taken by mouth. In patients with more severe lung infections, intravenous antibiotics may be required.

Medications may also be used to loosen secretions, dilate bronchial tubes and decrease inflammation, hopefully decreasing the risk of infection.

Routine used of inhaled steroids (for example, fluticasone propionate oral inhaler [Flovent]) using a hand held puffer may decrease production of secretions, allow dilation of bronchial tubes, and prevent progression of bronchiectasis. Inhaled steroids may not have enough anti-inflammatory activity, and in unusual cases, steroids taken by mouth (prednisone) may also be required.

Bronchodilator (for example, albuterol, ProAir, Ventolin HFA, Proventil HFA) and anticholinergic (for example, ipratropium bromide inhaler [Atrovent], tiotropium bromide inhalation powder [Spiriva]) inhaled medications dilate bronchial tubes and increase air flow into the lungs, making it easier for secretions to be cleared. The medication can be inhaled using a hand held puffer or with a nebulizer machine. Often, combination therapy with both a bronchodilator and inhaled corticosteroid (fluticasone and salmeterol oral inhaler [Advair], budesonide and formoterol fumarate dihydrate [Symbicort]) are prescribed.

Home oxygen supplementation may be needed if lung function decreases to the point atmospheric air does not supply enough oxygen to the body.

Some patients have only a small area of bronchiectasis, and surgery may be an option to remove the small segment of affected lung in these individuals. Surgery may be considered in other situations to remove part of a lung where infection cannot be controlled or where excessive bleeding cannot be managed.

Medically Reviewed by a Doctor on 12/11/2013

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