What are the treatment options for bronchiectasis (bronchiectasia)?


What are the treatment options for bronchiectasis (bronchiectasia)?

Bronchiectasis, also known as bronchiectasia, is incurable. Treatment focuses on controlling infections and secretions, relieving obstructions in the airway, sometimes surgically removing affected portions of lung, embolization, and preventing complications.

Medications that suppress coughing should not be used because they often worsen the condition.

Early and effective treatment can significantly reduce complications, such as low blood oxygen levels, respiratory failure, hemoptysis (spitting up blood or bloody sputum), and cor pulmonale (heart disease caused by very high resistance to the passage of blood through the lungs).

Infections - treated with antibiotics, bronchodilators and physical therapy (UK: physiotherapy) to promote secretion drainage. To prevent infection recurrence, antibiotics may be prescribed long-term; especially if the patient has cystic fibrosis. Oral antibiotics are typically given, unless it is a hard-to-treat infection, in which case it may be administered intravenously.

What is Bronchiectasis (Bronchiectasia)?

What Are The Signs And Symptoms Of Bronchiectasis (Bronchiectasia)?

What Are The Causes Of Bronchiectasis (Bronchiectasia)?

How Is Bronchiectasis (Bronchiectasia) Diagnosed?

Bronchodilators - these relax the muscles and open up the airways. They are usually breathed in as a fine mist using an inhaler or nebulizer. With an inhaled bronchodilator the medicine goes straight into the lungs and work quickly.

Hydration - if the patient consumes plenty of fluids, particularly water, the mucus in the airway is less likely to become thick and sticky. Thick and sticky mucus is harder to cough up.

Inflammation and mucus accumulation:

  • Corticosteroids - inhaled corticosteroids will probably be prescribed for inflammation. If inhaled steroid therapy is consistently adhered to, sputum production and airway constriction can be significantly reduced, helping prevent the progression of bronchiectasis.
  • Mucolytics and saline will be administered to thin the pus and mucus. According to the Merck Manual, the effectiveness of mucolytics is uncertain.
  • Postural drainage and chest percussion - to help drain the mucus. Postural drainage uses gravity; the patient is positioned at certain postures and angles to clear congestion. Chest percussion is a system of tapping (like slapping) with hollowed hands. Some call it chest physical therapy (CPT) or chest clapping. The chest and back are pounded again and again with cupped hands or a device - this helps loosen the mucus so that the patient can cough it up.

    If chest percussion is uncomfortable the patient may prefer an electric chest clapper (mechanical percussor), or an inflatable therapy vest that uses high-frequency air waves. There is also a small handheld device the patient breathes out through - the device causes vibrations which help loosen the mucus.

Bronchial obstruction - bronchoscopy is used to remove whatever is causing the blocking, and before severe damage occurs. Obstruction may be caused by, for example, a peanut lodged in the airway. A bronchoscope - a long, thin, flexible tube with a light and camera at the end goes into the airway via the mouth or nose; the doctor can see the inside of the airway on a monitor.

Surgery - part of a lung may need to be surgically removed (rare). Surgery is only an option if just one lung is affected, and preferably only one lung lobe or segment. Surgery may also be recommended for patients who still have recurrent infections despite treatment, as well as those who cough up large amounts of blood.

Embolization - used instead of surgery to stop bleeding for patients who cough up a lot of blood. A catheter is used to inject a substance that blocks the bleeding vessel.

Oxygen therapy - given to patients with low blood oxygen levels. This may occur if the bronchiectasis is widespread and causing respiratory failure.

Wheezing or shortness of breath - oral and inhaled corticosteroids may be prescribed, either on their own or with bronchodilators.

Lung transplantation - usually only recommended for patients with advanced bronchiectasis who also have cystic fibrosis.

Outlook (prognosis)

This depends on several factors, but mainly on how well infections and possible complications are controlled or prevented. Treatment that is started early on tends to have the best outcomes. Patients with co-existing conditions generally have worse outcomes. Examples of co-existing conditions include chronic bronchitis, emphysema. Individuals with complications, such as pulmonary hypertension or cor pulmonale tend to have worse outcomes.

  • What is Bronchiectasis (Bronchiectasia)?
  • What Are The Signs And Symptoms Of Bronchiectasis (Bronchiectasia)?
  • What Are The Causes Of Bronchiectasis (Bronchiectasia)?
  • How Is Bronchiectasis (Bronchiectasia) Diagnosed?

Bronchiectasis for USMLE (Video Medical And Professional 2020).

Section Issues On Medicine: Disease