Patient information from BMJ

Bronchiectasis: what treatments work?

Last published:Aug 05, 2021

Bronchiectasis is a lung disease that causes breathing problems and makes chest infections more likely.

You can use our information to talk with your doctor and decide which treatments are right for you. To learn more about what happens in bronchiectasis and its symptoms, see the leaflet Bronchiectasis: what is it?

How treatment can help

Bonchiectasis can't be cured, but there are treatments that can help you live with the symptoms. The aims of treatment are to:

• ease the main symptoms of bronchiectasis, such as coughing, mucus production, and breathing difficulties

• improve your quality of life

• reduce the number of exacerbations you have, and

• prevent more damage to your airways.

Exercises and physiotherapy

Exercises to strengthen your chest muscles can make it easier to breathe more freely and to live a more normal life. To train your chest muscles, you breathe in through a device that makes your muscles work harder.

You'll be shown how to use the device by a doctor, nurse, or other health professional. You'll probably have to do these exercises for 30 minutes a day, five days a week.

Many doctors recommend a type of physiotherapy that aims to clear mucus out of the lungs. Some people find it helpful to blow into a small device that helps them to loosen the mucus.

You might be asked to move into different positions, so that gravity helps the mucus to drain out of the lungs. A physiotherapist might tap your chest to loosen the mucus and help it start to move.

Medicines to help your breathing

Your doctor may also try some medicines to help you breathe more easily. The medicines might include:

• A bronchodilator (a drug to open up the airways). Bronchodilators are usually given by inhaler.

  These medicines can cause side effects, but they are not usually troublesome in the long term. For example, they make your hands tremble, especially when you first use them. They may also make you feel like your heart is beating faster. But this should go away if you reduce the dose.

• A mucolytic (a drug to break up mucus). These come as a drug that you breathe in through a mask. They are not recommended for people who don't have cystic fibrosis.

  These can cause flu-like symptoms in some people.

• Salt water (called hypertonic saline). This aims to make your mucus thinner. You breathe it in through a mask using a machine called a nebuliser.

Surgery

If parts of your lungs are very badly damaged your doctor may advise you to have an operation to remove the worst parts. But surgery for bronchiectasis is rare. Your doctor is more likely to suggest this if you often cough up a lot of blood and find it very hard to breathe properly.

In the most serious cases, doctors might recommend a lung transplant. But this is very rare.

Other treatments you may need

If you get a chest infection you'll need a course of antibiotics to kill the bacteria that are probably causing it. The sooner you start the antibiotics the better. So it's important to go to your doctor as soon as you notice:

• Any worsening of symptoms

• A change in the colour of the mucus being coughed up.

Your doctor may give you antibiotics to keep at home, so you can start taking them as soon as you feel an infection starting. But you should still go to the doctor to get the mucus tested, to check what bacteria you have. You might need a different antibiotic.

Because infections can lead to serious problems if you have bronchiectasis, you should make sure you get a flu vaccine every year.

Some people may get infections so often that they need to take antibiotics all the time. As well as preventing infections, this can give your lungs a chance to recover. Long-term antibiotics can be taken as tablets or with a nebuliser.

Using antibiotics in this way can sometimes lead to bacteria becoming resistant. If this happens the antibiotics don't work any more. So you might need to have your mucus checked regularly. If the bacteria become resistant you will need to change to a different antibiotic.