Bronchiectasis: Treatment

The management of bronchiectasis is long-term and is directed at:

• Improving the clearance of sputum, also called airway clearance or bronchopulmonary hygiene,

• Treatment of infections,

• Treatment of associated conditions (such as GERD or sinusitis),

• Improving muscle strength and endurance through pulmonary rehabilitation and

• Identifying the need for surgical resection of affected segments or lobes of the lung.

Your healthcare provider will evaluate your history and recommend the best management plan for you.

Bronchopulmonary Hygiene Therapy

Improved clearance of mucus is the cornerstone of the management of bronchiectasis and includes several components. They include:

• Inhaled medication (bronchodilator and/or inhaled steroid, saline) and/or

• Airway clearance measures (oscillating positive expiratory pressure device, high-frequency chest wall oscillation vest).

Your healthcare provider may recommend one or more of them depending on your individual needs.

Inhaled Medication

Inhaled Bronchodilators - An inhaled bronchodilator medication opens the airways by relaxing the smooth muscles around the airways. This type of medication is available in a number of inhaled forms. Commonly used inhaled short-acting bronchodilators include:

• ProAir RespiClick or HFA^®, Proventil^® HFA, Ventolin^® HFA (albuterol)

• Xopenex^® (levalbuterol) 

Inhaled long-acting bronchodilators may also be used. Long-acting bronchodilators can be either LABAs (long-acting beta2 agonists) or LAMAs (long-acting muscarinic antogonists).  LABA and LAMA are types of bronchodilators.

LAMAs include:

• Incruse^® (umeclidinium)

• Seebri^® (glycopyrronium)

• Spiriva^® (tiotropium)

• Tudorza^® (aclidinium)

LABAs include:

• Arcapta^® (indacaterol)

• Brovana^® (arformoterol)

• Perforomist^® (formoterol)

• Serevent^® (salmeterol)

• Stiverdi^® (olodaterol)

LAMA & LABA combinations include:

• Anoro^® (umedcldinium and vilanterol)

• Stiolto^® (olodaterol and tiotropium)

• Utibron^® (indacaterol and glycopyrolate)

Inhaled Steroids

Inhaled steroids reduce and prevent swelling inside the airways. Common inhaled steroids include:

• Alvescor (ciclesonide)

• Arnuity (fluticasone)

• Asmanex^® (mometasone)

• Flovent^® (fluticasone)

• Pulmicort^® (budesonide)

• QVAR^® (becolmethasone)

Inhaled Steroid and Long-Acting Bronchodilator Combinations

Common combinations of inhaled steroid and long-acting bronchodilator include:

• Advair^® (fluticasone and salmeterol)

• Breo^® (fluticasone and vilanterol)

• Dulera^® (mometasone and formoterol)

• Symbicort^® (budesonide and formorterol)

Inhaled hypertonic saline may be used to loosen airway mucus for easier clearance.  Common strengths of hypertonic saline are 3% and 7% and are generally used once or twice daily and are administered with a nebulizer.

Airway Clearance Measures

Airway clearance measures are treatments designed to clear trapped mucus from the airways.

Oscillating positive expiratory pressure devices (OPEPD): These include devices such as the Aerobika^®, Acapella^® or the Flutter Valve^® that help clear mucus from your lungs. These are small devices you inhale and/or exhale into.

High-frequency chest wall oscillation vests: These include The Vest® and the SmartVest® and AffloVest^® and are inflatable vests that you put on. The vest shakes your chest to help dislodge the mucus from the airway walls. Sometimes the Aerobika® or Acapella® is used after the inflatable vest. Once the mucus is dislodged, the device can help clear the mucus.

Postural drainage and clapping use gravity to promote drainage of mucus from the lungs.

Each technique can be prescribed by your health care provider. Correct technique using these devices is very important. Make sure a health care provider, often a Respiratory Therapist, experienced in the use of the device shows you how to use it. It is also important to have your technique checked periodically to make sure you continue to use it correctly to obtain the most benefit.

Treatment of Infections

Antibiotics are used to treat bacteria and other infectious organisms causing infection in the lungs in order to improve respiratory symptoms and prevent further damage to the airways. Antibiotics may be taken for a short or long period of time, depending on the infection. For example, treatment of Pseudomonas auruginosa may entail 2-3 weeks of intravenous antibiotics when symptoms are severe. Sometimes inhaled antibiotics are given to prevent exacerbations of Pseudomonas. Treatment of mycobacteria may require multiple antibiotics taken for a year or longer. Rotating or chronic oral antibiotics to prevent infection usually are not encouraged, because this promotes the development of drug-resistant organisms. However, long-term azithromycin may sometimes be beneficial to people who experience frequent bronchiectasis flareups.

Treatment of Associated Conditions

Treatment of any identified specific causes, including those listed under "Causes of Bronchiectasis" is important. Examples include:

• Treatment of chronic infections with non-tuberculous mycobacteria.

• Treatment of antibody deficiency with immune globulin if appropriate.

• Treatment of swallowing disorders and GERD that cause chronic pulmonary aspiration. The Med Facts, Gastroesophageal Reflux Disease, discusses this topic in more detail.

• Prompt treatment or removal of any foreign object, growth or tumor causing obstruction of the airways.

• Treatment of other chronic lung diseases.

• Treatment of chronic sinusitis.

Pulmonary Rehabilitation

Pulmonary rehabilitation may improve your overall health. A well-rounded rehabilitation program includes education, exercise and eating well and can help you stay healthy and feel good.

Resectional Surgery

Resectional surgery is occasionally indicated - usually only if bronchiectasis is very localized in the lung and medical treatment and other therapies are not effective.