Bronchiectasis is treated using a combination of:
- a series of exercises and, in some cases, specially designed devices to help clear your lungs of mucus
- medication to help improve the flow of air through the airways (bronchi) of your lungs; these are usually delivered using a device known as an nebuliser
- antibiotics to treat lung infections as and when they occur – in some cases antibiotics may also be used to help prevent infection
In a small number of cases surgery may also be recommended.
Exercise
There are a range of exercises, known as airway clearway techniques, which can help remove mucus from your lungs. This can often help improve symptoms of coughing and breathlessness.
You can be referred to a physiotherapist who can give you several airway clearway techniques.
The most widely used in the UK is called "active cycle of breathing techniques" (ACBT).
Active cycle of breathing techniques (ACBT)
ACBT involve you repeating a cycle made up of a number of different steps. These include a period of normal breathing, followed by deep breaths to loosen the mucus and force it up; then you cough the mucus out.
You then repeat the cycle for 20 to 30 minutes.
Don't attempt ACBT if you have not first been taught the steps by a suitably trained physiotherapist, as performing the techniques incorrectly could damage your lungs.
If you are otherwise in good health you will probably only need to perform ACBT once or twice a day.
If you develop a lung infection you may need to perform ACBT on a more frequent basis.
Postural drainage
Changing your position can also make it easier to remove mucus from your lungs. This is known as postural drainage.
Each technique can involve several complex steps but to summarise, most techniques involve you leaning or lying down while the physiotherapist or a carer uses their hands to vibrate certain sections of your lungs as you go through a series of "huffing" and coughing.
Devices
There are also devices that can help remove mucus from your lungs. These include:
- the flutter © – a handheld advice, shaped like an asthma inhaler, which delivers vibration to the airway of your lungs, making it easier to cough out mucus
- RC cornet © – shaped like a small section of garden hosing, which works in much the same way as the flutter
- the Acapella © – a device, shaped like a small torch, that uses a combination of vibration and air pressure to help remove mucus
These devices are not always available on the NHS so you may have to pay for one. They cost in the region of around £45 to £60.
The British Lung Foundation has complied a list of medical equipment suppliers that people with a chronic lung condition may find useful (note – the fact that a company has been included on the list does not mean that they have been endorsed by either NHS Choices or the British Lung Foundation).
Improving the airflow
As well as the exercises discussed above there are other treatments that can help improve the flow of air in and out of your lungs. These are discussed below.
Nebuliser
A nebuliser is a device, consisting of a:
- face mask or mouthpiece
- chamber – designed to convert a medication into a fine mist that is then pumped into your lungs
- compressor – a power source designed to pump the medication into your lungs
The face mask, mouthpiece and chamber, and the medication designed to go in the chamber, are usually available on prescription on the NHS. However, you will have to pay for the compressor which can cost anywhere between around £40 to £120 depending on the manufacturer.
Medications that can be administered using a nebuliser include:
- normal saline – which is water that contains a small amount of salt (the salt helps ensure that the water is free of germs)
- hypertonic saline – this is similar to normal saline but contains higher levels of salt as well as a number of other medications; the added minerals can be more effective in clearing out mucus from the airways of your lungs
- terbutaline – a type of medication known as a beta2-adrenergic agonist which works by helping to relax the airways; a dose of terbutaline is often given before a session of exercise to make the effects of exercise more effective
Other medications
You may be prescribed medications on a short-term basis if you have a particualry severe flare-up of symptoms, although these aren’t routinely used in most cases.
These could include:
- steroid inhalers (corticosteroids) – which help reduce inflammation inside the lungs
- bronchodilators – which help relax the muscle in the lungs making breathing easier; beta2-adrenergic agonist is one type of bronchodilator and other types include anticholinergics and theophylline
Antibiotics
If you experience a worsening of symptoms because of a bacterial infection (an infective exacerbation) then you will need to be treated with antibiotics.
A sample of sputum will be taken to determine what type of bacteria is causing the infection. But as testing can take a few days you will be initially treated with an antibiotic known to be effective against a number of different bacteria (a broad spectrum antibiotic).
Depending on the test results, you may be prescribed a different antibiotic, or in some cases, a combination of antibiotics.
If you are well enough to be treated at home you will probably be prescribed two to three antibiotic tablets a day for a 14-day course. It is important to finish the course even if you feel better as stopping the cause prematurely could cause the infection to reoccur quickly.
If your symptoms are more severe (see symptoms of bronchiectasis for a detailed description) then you may need to be admitted to hospital and treated with antibiotic injections.
Preventative treatment
If you have three or more infective exacerbations in any one year or your symptoms during an infective exacerbation were particualry severe then it may be recommended that you take antibiotics on a long-term basis. This can help prevent further infections and give your lungs the chance to recover.
This could involve taking low-dose antibiotic tablets (to minimise the risk of side effects) or using an antibiotic nebuliser.
Using antibiotics in this way does increase the risk that one or more types of bacteria will develop a resistance to the antibiotic. Because of this risk you may be asked to give regular sputum samples to check for any resistance. If bacteria do show signs of developing a resistance then your antibiotic may need to be changed.
Surgery
Surgery is usually only recommended where bronchiectasis is only affecting a single section of your lung (focal bronchiectasis) and your symptoms aren't responding to other treatment.
The lungs are made up of sections known as lobes – the left lung has two lobes and the right lung has three lobes.
Surgery for focal bronchiectasis would usually involve removing the lobe affected by the bronchiectasis in a type of operation known as a lobectomy. (If more than one lobe is affected then it surgery won’t go ahead as it’s dangerous to remove so much lung tissue.)
