How is bronchiectasis treated?

If you get a chest infection or have a flare-up, you’ll take a course of antibiotics, usually for 14 days.  

You should give a phlegm sample to your doctor at least once a year, or when you’re unwell and notice your symptoms changing. Your doctor might start you on antibiotics without having to wait for phlegm sample results.  

People who have bronchiectasis sometimes have bacteria in their phlegm that can be more difficult to clear, such as Pseudomonas and non-tuberculous mycobacterium (NTM). Your doctor will tell you the treatment options, such as inhaled antibiotics.

Long-term antibiotics

You may need to take antibiotics for much longer if you have several flare-ups a year.

Your doctor will discuss if this is the right option for you.

How are antibiotics taken?

Antibiotics can be taken as tablets or inhaled as a mist through a nebuliser.

If you’re really unwell, you might be given antibiotics directly into a vein. This is called intravenous antibiotics and they are normally given in hospital but can sometimes be given at home.

A respiratory physiotherapist will teach you airway clearance techniques (ACTs). ACTs will help to:  

• remove phlegm (sputum) from your lungs 
• control your cough
• reduce chest infections.

Your physiotherapist will tell you when to do your ACTs. They’ll usually suggest a routine for when you are well, and changes to make when you’re unwell. Some ACTs work better when timed with taking your medications.  Remember to keep hydrated by drinking plenty of water.

Active cycle of breathing techniques (ACBT)

The most common airway clearance technique used in the UK is the active cycle of breathing techniques (ACBT). 

The Association of Chartered Physiotherapists in Respiratory Care (ACPRC) have more information on the active cycle of breathing techniques.

If your phlegm is sticky and hard to cough up, or if you have more than three flare-ups in a year, your healthcare professional may suggest:

• a check-up with a respiratory physiotherapist 
• a device to help clear your chest. For example, Acapella or Aerobika positive expiratory pressure therapy (PEP) devices. Speak to your healthcare professional about whether you need one of these. 
• a mucolytic drug to break up the phlegm and make it easier to clear from your lungs
• a nebuliser to breathe in a salt solution called saline. This may help if you have a lot of infections and find it difficult to clear phlegm from your lungs with physiotherapy. The saline helps break up the phlegm and makes it easier to cough up.

Some people with bronchiectasis don’t get short of breath, and for others, it’s the main symptom.  Becoming more breathless can be a sign of a chest infection and you will need to take antibiotics to treat the infection.

Keeping active can help with breathlessness too. It makes your muscles stronger, meaning they work better, which can help you manage your breathlessness. Read more about keeping active.

Over time you’ll learn what level of breathlessness is normal for you. If you get breathless, pacing your activities can really help. We have more information on living well with breathlessness, including information on sex and breathlessness.

Pulmonary rehabilitation

If you get breathless, ask your healthcare professional about pulmonary rehabilitation (PR).

PR is a six to eight week course led by a respiratory physiotherapist. The course includes:  

• a physical exercise programme made for you 
• information on looking after your body and lungs
• advice on managing your condition
• information on managing breathlessness.

If you have bronchiectasis, it’s important to get vaccinated against harmful viruses and infections.  Make sure you get:

• a yearly flu vaccination 
• coronavirus vaccines and boosters 
• a pneumonia vaccine

Living with a lung condition like bronchiectasis can sometimes put extra pressure on your bladder, bottom, and pelvic floor muscles.

Some people with bronchiectasis may pee or sometimes poo when coughing or laughing. Strengthening the muscles used to control your bladder and bottom is a good way of treating incontinence. There are a lot of ways to do this. You can:  

• speak to your GP or doctor about referring you to a continence nurse
• try the ‘Squeezy’ pelvic floor app.

Surgery

Surgery for bronchiectasis is rare. It can be an option for people who have bronchiectasis in a specific area of the lungs and whose symptoms are not controlled by other treatment.

Embolisation

If you cough up blood, you may have a scan called bronchial angiography to look at the blood vessels in your lungs. If this shows blood vessels that cause bleeding, a surgery called embolisation can be done to block off the blood vessels that cause the bleeding. 

Lung transplant

A lung transplant is rarely needed in bronchiectasis. It’s for people who have very severe lung disease and no other treatment options.

Oxygen therapy

Most people with bronchiectasis do not require oxygen therapy. However, if your oxygen levels are low you may need to breathe in oxygen through a tube or mask. This might be short-term because of a chest infection, or long-term if your lungs are damaged.

Check-ups  

Make sure you review your treatment with your healthcare professional at least once a year.

At your yearly reviews, you can expect to:

• give phlegm (sputum) samples for testing
• review your symptoms
• review how often you have flare-ups 
• change any treatment if needed.