Bronchiectasis

What is the treatment for bronchiectasis?

Treatment for bronchiectasis aims to prevent further damage and infection in your lungs and reduce your symptoms.

You’ll be given:

  • a personalised self-management plan to help you control your symptoms
  • airway clearance techniques (breathing exercises) to clear your sputum. Doing these regularly will reduce the number of infections you get and keep you well
  • treatment with antibiotics for flare-ups or chest infections
  • annual flu vaccinations
  • treatment for other conditions causing your bronchiectasis – for example problems with your immune system.

Bronchiectasis treatment involves getting to know your body and what’s right for you. Make sure you agree a written self-management plan with your health care professional. This will help you to manage your symptoms.

On this page:


Antibiotics

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

It is important to take your antibiotics as directed. This includes completing the full course of antibiotics.

The antibiotics used may vary depending on which bacteria are in your sputum. So it is very important to give a sputum sample to your doctor at least once a year even if you are well, and when you notice things changing. You will start a course of antibiotics without having to wait for the results.

The choice of antibiotics will be guided by what bacteria you had in the past or which antibiotics worked best for you. If analysis of your sputum shows new bacteria or bacteria that will not be treated by the antibiotics you’ve started, your doctor may prescribe another one.

People who have bronchiectasis sometimes have different bacteria in their sputum that can be more difficult to clear, such as Pseudomonas aeruginosa and non-tuberculous mycobacterium (NTM). If this is the case for you, your doctor will discuss the treatment options, which may include inhaled antibiotics.

You’ll sometimes be given antibiotics injected into a vein in your arm. This may be done in hospital, or you can learn how to do this at home.

You may be offered long-term antibiotics, either as tablets or inhaled through a nebuliser, if:

  • you have 3 or more infections a year, and
  • you have recently been reviewed by a specialist physiotherapist to make sure sputum is being cleared from your lungs as well as possible.

Clearing your sputum

Clearing sputum from your lungs is very important and can reduce the number of infections you have and reduce your cough.

Try to keep hydrated and drink plenty of water.

Ask to see a respiratory physiotherapist.

They’ll discuss ways you can remove sputum from your lungs and find airway clearance techniques that suit you.

Your physiotherapist will recommend how often, and when, to do them. They’ll usually recommend a routine for when you are well, and changes to make when you’re unwell. Some physiotherapy techniques work best when timed with your medications.

Techniques include moving into positions so gravity helps the sputum drain out of your airways and lungs. The physiotherapist might tap your chest to loosen the sputum and to help it start to move. Some people find it helps to blow into a small device to clear their chest. Examples are the Acapella and Aerobika flutter valves, and the positive expiratory pressure (PEP) valve (NHSGGC website) . These devices aren’t always available on the NHS. Talk to a health care professional before you buy one – or you might end up with something that isn’t right for you.

Your physiotherapist can tell you about the active cycle of breathing techniques to do daily at home. They include:

  • breathing control – breathing gently, through your nose if possible. Keep your shoulders relaxed
  • deep breathing – taking a long, slow, deep breath in through your nose if possible, holding your breath for 2 to 3 seconds, and breathing out gently, like a sigh
  • huffing – breathing out through an open mouth instead of coughing. To huff, you squeeze air quickly from your lungs, out through your mouth and throat as if you are trying to mist a mirror.

There is more information about these techniques on the ACPRC website.

It can be helpful to watch videos of airway clearance techniques (NHSGGC website).

If your sputum is sticky and hard to cough up, or if you have more than 3 exacerbations in a year, your health care professional may suggest:

  • a check-up with a respiratory physiotherapist
  • a mucolytic: a drug to break up the sputum 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 frequent infections and find it difficult to clear sputum from your lungs by physiotherapy. The salt water helps break up the sputum and make it easier to cough up.

How can I cope with breathlessness

Some people don’t get short of breath at all, for others it’s the main symptom. Becoming more breathless can be a sign of a chest infection. Over time you’ll learn what level of breathlessness is normal for you. Feeling out of breath can be frightening - get medical help if you’re concerned about a change in your level of breathlessness.

If you do get breathless, pacing your activities can really help. Talk to your physiotherapist about this.

It might be daunting, but exercise can help with breathlessness too. Muscles that are stronger use oxygen more efficiently so your lungs have to work less hard when you’re active.

What about sex and breathlessness?

Like any physical activity, sex can leave you short of breath. Read more about how to manage sex and breathlessness.

If you get breathless, ask your health care professional about attending a breathlessness management class called pulmonary rehabilitation or PR.

PR is a 6-to-8-week course led by a qualified respiratory professional that covers:

  • a physical exercise programme designed for people living with lung conditions and tailored to you
  • looking after your body and lungs, managing your condition and coping with feeling short of breath

Help to stop smoking

If you smoke, stopping is very important. The NHS offers a free stop smoking service – your GP can refer you. Find out more about quitting smoking.


Reducing bladder leakage or cough incontinence

Living with a long-term cough puts extra pressure on your bladder, bowel and pelvic floor muscles. Many people living with bronchiectasis tell us they have problems with stress incontinence - leaking urine (and rarely faeces) during forceful movements such as when they’re coughing or laughing. Evidence suggests exercises that strengthen muscles, called the pelvic floor muscles, are an effective treatment.

Don’t be embarrassed if you have problems with your bladder or bowel. Discuss this with your health care professional as soon as you can – they’re used to helping.

They can give you exercises and refer you to a specialist, who can help with training in exercises to strengthen your pelvic floor muscles and other techniques.

This video on bronchiectasis.me explains more about the role of a continence nurse.


Vaccinations

Make sure you get your flu jab every year. The NHS offers it for free to people living with long-term conditions like bronchiectasis. Your doctor should also offer you a one-off vaccination against pneumococcal infection – a bacterial infection that can cause pneumonia and other illnesses.

If you have bronchiectasis, you’re more likely to get unwell if you are around people who have colds or chest infections.

 If you get signs of an infection for more than 2 days, make sure you treat it quickly by seeing your GP or taking your prescribed antibiotics.


Other treatments

Surgery

Today, surgery in bronchiectasis is quite rare, as it helps only a few people. It’s sometimes considered for people who have bronchiectasis in a limited area of one lung and have not responded to other treatments.

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 procedure called embolisation can block off the blood vessels causing the trouble.

Lung transplantation

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

Oxygen

Your oxygen saturation levels will be checked as part of your breathing tests. Most people with bronchiectasis do not require oxygen.

Vitamin D

There is some evidence that people with bronchiectasis can have insufficient levels of vitamin D, which is needed for healthy bones, teeth and muscles. Your health care professional might test your vitamin D levels. Current government advice is that adults should have 10 micrograms of vitamin D every day.

Check-ups

Make sure you review your treatment with your health care professional at least once a year. You’ll give some sputum for analysis and review how often you have flare-ups.

Next: coping with flare-ups >

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Last medically reviewed: March 2020. Due for review: March 2023

This information uses the best available medical evidence and was produced with the support of people living with lung conditions. Find out how we produce our information. If you’d like to see our references get in touch.