From the Guidelines
Post-operative care for bronchiectasis patients should prioritize airway clearance, infection prevention, and optimizing respiratory function to reduce morbidity, mortality, and improve quality of life. The most recent and highest quality study, the British Thoracic Society guideline for bronchiectasis in adults 1, recommends that patients undergo pre-surgical safety assessment to define the expected amount of residual lung, underlying cardiopulmonary reserve, and anticipated overall risks.
Key post-operative recommendations include:
- Daily airway clearance techniques, such as postural drainage, chest physiotherapy, and devices like flutter valves or positive expiratory pressure (PEP) devices for 20-30 minutes, 2-3 times daily
- Use of bronchodilators like albuterol (2 puffs every 4-6 hours as needed) before airway clearance to enhance effectiveness
- Adequate hydration with 2-3 liters of fluid daily to thin secretions
- Prophylactic antibiotics, such as azithromycin 500mg three times weekly, for patients with frequent exacerbations
- Pulmonary rehabilitation initiated within 2-4 weeks post-surgery to improve exercise capacity and quality of life
- Pneumococcal and annual influenza vaccinations to prevent respiratory infections
- Smoking cessation, as continued smoking worsens bronchiectasis
- Regular follow-up appointments every 3-6 months to monitor disease progression and treatment response
These interventions are crucial in reducing mucus retention, preventing respiratory infections, and maintaining optimal lung function, which is particularly important after surgery when patients may have reduced mobility and increased secretion production 1. The European Respiratory Society guidelines for the management of adult bronchiectasis also emphasize the importance of a multidisciplinary approach to patient care, including specialists in respiratory medicine, microbiology, physiotherapy, thoracic surgery, and primary care 1.
From the Research
Post-Operative Recommendations for Bronchiectasis
- The current management of bronchiectasis includes oral, aerosolized, or intravenous antibiotic therapy, and mucus clearance by means of bronchial hygiene assistive devices, chest physiotherapy, postural drainage, and high-frequency chest compression 2
- An algorithm of care that includes chest physiotherapy has been shown to reduce hospitalizations and stabilize lung function in patients with bronchiectasis 3
- Azithromycin has been found to be beneficial in reducing sputum volume, improving quality of life, and stabilizing lung function in patients with bronchiectasis 4, 5
- Pulmonary rehabilitation has been shown to be effective in improving symptoms, quality of life, and exercise capacity in patients with bronchiectasis, regardless of sex, etiology, smoking status, or number of hospitalizations 6
Treatment Options
- Aerosolized antibiotics, such as those used for patients infected with Pseudomonas aeruginosa, may be a useful treatment option 2
- High-frequency chest wall oscillation (HFCWO) therapy has been found to be effective in reducing hospitalizations and stabilizing lung function in patients with bronchiectasis 3
- Azithromycin has been found to be effective in reducing sputum volume, improving quality of life, and stabilizing lung function in patients with bronchiectasis 4, 5
- Pulmonary rehabilitation, including education and training on bronchial hygiene, has been shown to be effective in improving symptoms, quality of life, and exercise capacity in patients with bronchiectasis 6
Factors Associated with Improvement
- Age, baseline forced expiratory volume in 1 second (FEV1), and baseline Medical Research Council (MRC) dyspnea scale have been found to be associated with improvement in patients with bronchiectasis undergoing pulmonary rehabilitation 6
- Baseline quality of life, as measured by the St. George's Respiratory Questionnaire (SGRQ), has been found to be associated with improvement in patients with bronchiectasis undergoing pulmonary rehabilitation 6