| Bronchiectasis |
| What are the treatments for bronchiectasis? |
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Your doctor may advise one or more of the following.
The treatment options chosen may depend on the severity of the
condition. |
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Antibiotics: Antibiotics are the
'mainstay' of treatment. If you have mild bronchiectasis, you
are likely to need a course of antibiotics every 'now and then'
to clear chest infections as and when they occur. A change
of the colour of your sputum to green and feeling unwell usually
indicates that you have a chest infection. If you have more
severe bronchiectasis, chest infections may return quickly
once you stop taking antibiotics.
In this situation you may
be advised to take antibiotics regularly to prevent infections
from developing. One option for this is 'pulsed' antibiotic
treatment which is regular short courses of antibiotics with
breaks in treatment between the courses. Another option is
to take antibiotics every day indefinitely. Recently, taking
regular antibiotics by inhaler (nebuliser) rather than antibiotic
tablets has become more popular. This is because it can deliver
high doses of the antibiotic directly into the airways with
relatively small amounts getting into the body. This reduces
the problem of possible side-effects. |
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Physiotherapy and Pulmonary Rehabilitation: The
aim of physiotherapy and other exercise
therapies is to help
you to cough up and clear the mucus, and to improve your overall
lung fitness. This may prevent a build-up of infected mucus,
which may prevent chest infections. A physiotherapist will
advise on the correct way to drain the affected areas. For
example, it may mean that once or twice a day you should adopt
a 'head down' position and do some controlled breathing exercises
to clear the build up of mucus.
This is often combined with
chest clapping by yourself, or by a relative, carer, or friend.
It takes time and effort to do this properly and regularly.
More recently, various devices have been designed which help
to improve the drainage of mucus.
In addition, if you are able,
a daily exercise activity such as running, brisk walking, swimming,
dancing, aerobics, etc, may help to clear the mucus too. Physiotherapy
and exercise therapies have been a main treatment for many
years. However, research studies to provide evidence in support
of these therapies is variable and conflicting. More research
is needed to confirm the place of these therapies. |
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A
steroid inhaler: Steroid drugs reduce inflammation.
The regular use of a steroid inhaler may reduce inflammation
and improve airflow through the airways. Steroid inhalers
are the main treatment for asthma (another disease of the
airways). Some studies suggest that they may also help
with bronchiectasis. For example, a research study published
in 2005 described 86 people with bronchiectasis who either
took fluticasone 500 μg (a steroid inhaler) twice daily
or placebo (a dummy inhaler) for 12 months. The results
showed that the amount of sputum coughed up decreased significantly
in those treated with fluticasone compared to those who
had the placebo inhaler. However, no change was seen in
the number of flare-ups of infection, nor in overall lung
function. So, this suggests that at least the burden of
coughing up large amounts of sputum may be eased with the
use of a steroid inhaler. |
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Bronchodilator inhalers: Bronchodilator inhalers
are commonly used in asthma to 'relax' and open wide (dilate)
the airways. There are a number of types, for example, salbutamol
inhaler. Studies that have looked into their use in bronchiectasis
show conflicting results. They may be of use in some cases.
Further research is needed to clarify the role of bronchodilator
inhalers for bronchiectasis. |
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Immunisation: Immunisation against the pneumococcus
bacterium and an annual 'flu jab' is advised. This reduces
the chance of some types of chest infection developing. |
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Do not smoke: Smoking makes symptoms worse and
smokers are very strongly advised to stop. Also, avoid 'passive
smoking' - that is, breathing in the smoke from people smoking
nearby. |
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Surgery: An operation may be an option if you
have a small local area of lung damage causing symptoms. Cutting
out the damaged airway may cure the problem. Surgery may be
considered even if you have widespread bronchiectasis. This
may be to cut out a particularly bad area of lung that is acting
as a reservoir for mucus and infection. Occasionally, a lung
transplant may be considered in severe cases. |
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| What is the outlook (prognosis)? |
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Most people with bronchiectasis (with no underlying
cause) have a good outlook. Symptoms in many affected people do
not become severe. Treatment, in particular antibiotics when an
infection occurs, or regularly when needed, keeps most people reasonably
well.
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The condition becomes worse in some cases, and breathing
problems may develop. In a small number of cases the condition
becomes gradually worse over time as more and more of the airways
become affected. A life-threatening bleed from a damaged airway
may also occur, but is rare. The outlook for people where bronchiectasis
is part of another condition depends on the underlying cause |
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Peter Scott - Team Leader
