The airways change shape and become loose and dilated. They gradually lose the ability to facilitate air flow to the lungs.
Treatment focuses on controlling infections and secretions, relieving obstructions in the airways, surgically removing affected portions of the lung, stemming any bleeding, and preventing complications.
It is also vital to slow or stop exacerbations of bronchiectasis. These are acute instances of infection or heightened sputum production or infection that indicate progression of the overall condition. If three or more classic symptoms of bronchiectasis present for two or more days, it is considered an exacerbation.
Early and effective treatment can significantly reduce complications, such as low blood oxygen levels, respiratory failure, coughing or spitting up blood, and heart disease caused by high resistance to the passage of blood through the lungs.
- Bronchiectasis is, in most cases, incurable, and severely reduces the capacity of the lungs to absorb oxygen.
- Treatment aims to manage symptoms and reduce the risk of complications or exacerbations.
- A combination of medication, therapy, and surgery can be used to improve the quality of life of an individual with bronchiectasis.
- Recent advances in bronchiectasis treatment include considering the use of non-steroidal anti-inflammatory drugs (NSAIDs) and macrolides.
Bronchiectasis treatment aims to prevent exacerbation and balance oxygen levels in the body.
Medications that treat bronchiectasis are available for oral ingestion, inhalation, or intravenous (IV) application through a drip.
Inhalers and nebulizers are the most effective delivery method for bronchiectasis treatment. These allow the medication to be breathed in, and to reach affected areas of the lungs more swiftly and effectively than oral medicines.
Long-term antibiotics may be prescribed to prevent the recurrence of infection. Oral antibiotics are typically given unless the infection is hard to treat. IV antibiotics may then be administered.
Medication options for bronchiectasis include:
- Bronchodilators: These relax the lung muscles and open up the airways. They are usually breathed in as a fine mist using an inhaler or nebulizer. With an inhaled bronchodilator, the medicine is delivered straight to the lungs and works quickly.
- Corticosteroids: Inhaled corticosteroids are likely to be prescribed for inflammation. If inhaled steroid therapy is consistently applied, sputum production and airway constriction can be significantly reduced. This helps to prevent the progression of bronchiectasis.
- Mucolytics and saline solution: This has been administered to thin pus and mucus. However, mucolytics are not confirmed as safe and effective for long-term use in the treatment of bronchiectasis.
- Herbal medication: Disciplines such as Ayurveda claim to offer effective medicinal management for bronchiectasis. To date, there is no confirmation of the safety and clinical efficacy of Ayuvedic medicine for bronchiectasis.
Medications that suppress coughing should not be used as they often worsen the condition.
Medications may be administered alongside different therapies for the best results.
Physical therapy: In bronchiectasis, physical therapy is used to loosen and clear mucus in the lungs. The techniques applied include postural drainage and chest percussion.
Postural drainage uses gravity to unclog the lungs. The patient is placed at certain postures and angles to clear mucus.
Chest percussion is a system of firm tapping with hollowed hands, similar to slapping. It is sometimes referred to as chest physical therapy (CPT) or chest clapping.
The chest and back are pounded repeatedly with cupped hands or a device. This helps to loosen the mucus so that the patient can cough and remove it from the body.
If chest percussion becomes uncomfortable, an electric chest clapper or an inflatable therapy vest that produces high-frequency airwaves may be used. The therapist may also use a small handheld device, through which the patient exhales.
The device causes vibrations that also assist with the shifting of mucus.
Oxygen therapy: This is given to patients with low blood oxygen levels. An oxygen shortage may occur if bronchiectasis is widespread and causing respiratory failure.
Oxygen therapy is administered from a canister of oxygen through tubes inserted into the nose and throat, or through a facemask, to significantly boost oxygen levels in the body.
Salt therapy: A natural treatment proposed for bronchiectasis is salt therapy, or speleopathy. This usually occurs in salt rooms, or salt caves, and involves the inhalation of salt particles in the air.
There is no clinical evidence that this is effective in the treatment of respiratory diseases.
Surgical or Procedural options
Surgery will, in rare cases, be required to improve the symptoms of bronchiectasis.
In more severe or persistent cases, surgery may be required to alleviate symptoms.
Bronchoscopy: This is used in cases of bronchial obstruction to remove whatever is causing the blockage before it leads to severe damage.
Obstruction may be caused by, for example, a peanut lodged in the airway. A bronchoscope is used for this procedure. This is a long, thin, flexible tube with a light and camera at the end. It is inserted into the airway via the mouth or nose. The doctor can see the inside of the airway on a monitor.
Embolization: A catheter is used to inject a substance that blocks the bleeding vessel. This is administered instead of surgery to stop bleeding in patients who cough up a lot of blood.
Removal of part of a lung: In rare cases, part of a lung may need to be surgically removed.
This surgery may also be recommended for patients who still have recurrent infections despite treatment, as well as those who cough up large amounts of blood.
Lung transplant: A transplant may be recommended for patients with advanced bronchiectasis who also have CF.
This depends mainly on the successful control of infections and possible complications.
Starting treatment early in the development of the condition tends to lead to the best outcomes. People who have bronchiectasis with a co-existing condition, such as chronic bronchitis and emphysema, generally have less likelihood of a positive outcome.
People with complications of bronchiectasis, such as pulmonary hypertension, also tend to have more difficulty with managing symptoms.
Recent advances in treatment
The next steps in combating the effects of bronchiectasis are currently at the stage of clinical trial. While none of these are confirmed as safe and effective, current research gives an indicator of where management of the condition is headed.
The advances for bronchiectasis treatment seem to focus on the type and delivery method of medication. These include:
Non-steroidal anti-inflammatory drugs (NSAIDs): At present, there is a limited amount of evidence to suggest that the use of NSAIDs in people who have both CF and bronchiectasis has clinical efficacy. No studies at present support the use of anti-inflammatories in people who only have bronchiectasis.
A combination of inhaled corticosteroids and long-acting beta 2 agonists: Beta 2 agonists are usually prescribed to treat asthma and prevent the constriction of the airways. These have shown small but statistically insignificant improvements on breathing difficulties in people with bronchiectasis.
They would also increase the risk of pneumonia and suppressed adrenalin levels when used on a long-term basis.
Macrolides: A macrolide is a type of antibiotic that has demonstrated anti-inflammatory, antimicrobial, and immunomodulatory properties. This means that they can combat infection, reduce swelling and irritation, and moderate the response of the immune system. Macrolides have been shown to reduce the number of exacerbations of bronchiectasis.
Bronchiectasis cannot be completely resolved, but appropriate and timely treatment can help improve quality of life for a person with the condition.