From the Guidelines
The treatment approach for bronchiectasis focuses on managing symptoms, preventing exacerbations, and slowing disease progression, with a comprehensive approach that includes airway clearance techniques, antibiotics, bronchodilators, and addressing underlying causes, as recommended by the European Respiratory Society guidelines 1.
Key Components of Treatment
- Airway clearance techniques such as chest physiotherapy, postural drainage, and devices like flutter valves or positive expiratory pressure masks to help clear mucus
- Antibiotics for treating acute exacerbations, with common choices including amoxicillin-clavulanate, azithromycin, or ciprofloxacin based on sputum culture results
- Long-term macrolide therapy such as azithromycin for patients with frequent exacerbations (3 or more annually) 1
- Bronchodilators like albuterol to manage airflow obstruction, while inhaled corticosteroids are considered for patients with concurrent asthma or COPD
- Mucolytics such as hypertonic saline to improve mucus clearance
- Addressing underlying causes, including treating primary conditions like immunodeficiency or rheumatoid arthritis
- Vaccination against influenza and pneumococcal disease to prevent respiratory infections
Considerations for Treatment
- The goal of treatment is to break the vicious cycle of chronic bacterial infection, inflammation, impaired mucociliary clearance, and structural lung disease 1
- Treatment should be individualized based on the patient's symptoms, physical capability, and disease characteristics 1
- Long-term antibiotic therapy should be considered only after optimization of general aspects of bronchiectasis management (airway clearance and treating modifiable underlying causes) 1
- Surgical resection of severely damaged lung segments or lung transplantation may be considered in severe cases 1
Recent Guidelines and Recommendations
- The European Respiratory Society guidelines recommend a comprehensive approach to managing bronchiectasis, including airway clearance techniques, antibiotics, bronchodilators, and addressing underlying causes 1
- The British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease recommends long-term macrolide therapy for patients with frequent exacerbations (3 or more annually) 1
From the Research
Treatment Approach for Bronchiectasis
The treatment approach for bronchiectasis involves a combination of pharmacological and non-pharmacological interventions. The goals of therapy are to:
- Improve airway mucus clearance through physiotherapy with or without adjunctive therapies 2
- Suppress, eradicate, and prevent airway bacterial colonization 2
- Reduce airway inflammation 2, 3
- Improve physical functioning and quality of life 2, 4
Pharmacological Treatments
Pharmacological treatments for bronchiectasis include:
- Long-term macrolide therapy, which has been shown to be beneficial in reducing exacerbations and improving quality of life 2, 4
- Inhaled antibiotics, which can help reduce airway bacterial colonization 4
- Oral antibiotics, such as amoxicillin-clavulanate, which can be used to treat acute respiratory exacerbations 5
- Anti-inflammatory therapies, such as glucocorticoids and biologic therapies, which may be beneficial for patients with eosinophilic inflammation 3
Non-Pharmacological Treatments
Non-pharmacological treatments for bronchiectasis include:
- Physiotherapy, which can help improve airway mucus clearance 2, 4
- Pulmonary rehabilitation, which can help improve physical functioning and quality of life 2, 4
- Airway clearance techniques, which can help reduce airway inflammation and improve mucociliary clearance 4
Personalized Treatment Approach
A personalized treatment approach is essential for managing bronchiectasis, as the disease is highly heterogeneous in its aetiology, impact, and prognosis 2, 4. The treatment approach should be tailored to the individual patient's needs and should take into account their specific symptoms, exacerbation history, and comorbidities.