Bronchiectasis Treatment

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The goals of treatment are to:

• Treat any underlying conditions and lung infections
• Remove mucus (a slimy substance) from your lungs
• Prevent complications

These goals are achieved through medicines, hydration, and chest physical therapy (CPT). If bronchiectasis occurs in only a section of the lungs or if you have a lot of bleeding, your healthcare provider may recommend surgery. If bronchiectasis is widespread and causes respiratory failure, your provider may recommend oxygen therapy.

Early diagnosis and treatment of the underlying cause of bronchiectasis may help prevent further lung damage. 

Antibiotics

Oral antibiotics are often used as the main treatment for repeated lung infections ( exacerbations ) due to bronchiectasis. The normal course of treatment is 14 days.

Research for a therapy to treat non–cystic fibrosis bronchiectasis is ongoing.

For hard-to-treat infections, your healthcare provider may prescribe intravenous (IV) antibiotics. These medicines are given through an IV line inserted into your arm. Your provider may help you arrange for a home care provider to give you IV antibiotics at home.

To reduce risk of exacerbations, inhaled antibiotics may be used if you have a chronic infection.

Expectorants and mucus-thinning medicines

Your healthcare provider may prescribe expectorants and  mucus  thinners to help you cough up mucus.

Expectorants help loosen the mucus in your lungs. They are often combined with decongestants, which may provide extra relief. Mucus thinners, such as acetylcysteine, loosen the mucus to make it easier to cough up.

Other medicines

Your healthcare provider may prescribe other medicines, depending on your symptoms or other conditions you may have.

• Bronchodilators relax the muscles around your airways. This helps open your airways and makes breathing easier. Most bronchodilators are inhaled medicines. You will use an inhaler or a nebulizer to breathe in a fine mist of medicine. Inhaled bronchodilators work quickly, because the medicine goes straight to your lungs. Your provider may recommend that you use a bronchodilator right before you do chest physical therapy.
• Inhaled corticosteroids treat  inflammation  in the airways but should be used only if asthma or COPD is present and your provider prescribes them.
• Mucus thinners make it easier to clear the mucus from your airways. These treatments are taken by inhaling them.

Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. Good hydration helps keep airway mucus moist and slippery and easier to cough up.

Chest physical therapy (CPT) is also known as physiotherapy, chest clapping, and percussion. This technique is generally performed by a respiratory therapist but can be done by a trained member of the family. It involves the therapist patting or gently pounding your chest and back repeatedly with their hands or a device. Doing this helps loosen the mucus from your lungs so you can cough it up.

You can sit with your head tilted down or lie on your stomach with your head down while you do CPT. Gravity and force help drain the mucus from your lungs.

Some people who perform CPT find it hard or uncomfortable to do. The following devices can help with CPT:

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

Airway clearance techniques help loosen lung mucus so it can be cleared, reducing infections and improving breathing. The techniques include special ways of breathing and coughing, devices used by mouth and therapy vests that use vibrations to loosen mucus, and chest physical therapy. These techniques are often used along with medicines such as bronchodilators and mucus thinners.

Several breathing techniques are also used to help move mucus to the upper airway so you can cough it up. These techniques include forced expiration technique (FET) and active cycle of breathing technique (ACBT).

FET involves forcing out a couple of breaths and then doing relaxed breathing. ACBT is FET that also involves deep breathing exercises.

Oxygen therapy and surgery are also options. Your healthcare provider may recommend surgery if no other treatments have helped. If you have major bleeding in your airway, your provider may recommend surgery to remove part of your airway to control the bleeding.

In very rare instances of severe bronchiectasis, your provider may recommend that you receive a lung transplant to provide you with a healthy set of lungs.