From the Guidelines
Bronchiectasis management should focus on preventing exacerbations, controlling symptoms, and slowing disease progression, with the cornerstone of treatment being airway clearance techniques and pulmonary rehabilitation, as recommended by the European Respiratory Society guidelines 1. The goal of treatment is to break the vicious cycle of chronic bacterial infection, inflammation, impaired mucociliary clearance, and structural lung disease.
- Airway clearance techniques, such as active cycle of breathing, postural drainage, and devices like flutter valves or positive expiratory pressure masks, should be performed daily to improve mucociliary clearance and reduce mucus stasis.
- Pulmonary rehabilitation is recommended for patients with exercise limitation or frequent exacerbations to improve quality of life and reduce symptoms.
- For acute exacerbations, antibiotics should be prescribed based on previous sputum cultures, typically for 14 days, with common choices including amoxicillin-clavulanate (875/125 mg twice daily), ciprofloxacin (500-750 mg twice daily), or azithromycin (500 mg daily) 1.
- For patients with frequent exacerbations (≥3 per year), consider long-term macrolide therapy, such as azithromycin 250-500 mg three times weekly, as recommended by the British Thoracic Society guideline 1.
- Inhaled bronchodilators, such as albuterol or ipratropium, are useful for patients with reversible airflow obstruction, while inhaled corticosteroids are generally reserved for those with concurrent asthma or COPD.
- Mucolytics, such as hypertonic saline (3-7%) or inhaled mannitol, may help with mucus clearance, and inhaled antibiotics, such as tobramycin (300 mg twice daily) or colistin (1-2 million units twice daily), may be beneficial for patients with Pseudomonas aeruginosa infections.
- Addressing underlying causes, maintaining hydration, and ensuring vaccinations against influenza and pneumococcus are essential components of comprehensive management, as they can help reduce the risk of exacerbations and improve quality of life 1.
From the Research
Bronchiectasis Management Overview
- Bronchiectasis is a chronic respiratory disease that requires a comprehensive management approach 2, 3, 4.
- The goals of therapy for bronchiectasis are to improve airway mucus clearance, suppress airway bacterial colonization, reduce airway inflammation, and improve physical functioning and quality of life 2, 3, 4.
Treatment Options
- Long-term macrolide therapy has been shown to be beneficial in bronchiectasis management 2, 3, 4.
- Inhaled therapies, physiotherapy, and pulmonary rehabilitation are also effective interventions 2, 3.
- Airway clearance techniques and inhaled antibiotics can improve mucociliary clearance and reduce airway infection 3.
Diagnostic Management
- Diagnosis of bronchiectasis requires both radiological and clinical features to be present 5, 6.
- Determination of the etiology of bronchiectasis is important to allow specific treatment and should be guided by clinical features 6.
- A multidisciplinary approach is required for the diagnostic work-up of children and adolescents with bronchiectasis 5.
Patient Care and Follow-up
- Patients with bronchiectasis should be followed up every 3 to 6 months, with closer monitoring for those with severe disease 5.
- Transition to adult care should be individualized, with emphasis on patient education, treatment adherence, and multidisciplinary support 5.
- A partnership between patients and health care professionals is key to successful outcomes 6.