Materiały źródłowe

• #1 Bronchiectasis management in adults: state of the art and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11211698/

  Formerly regarded as a rare disease, bronchiectasis is increasingly recognised. […] Randomised clinical trials (RCTs) have demonstrated the benefits of airway clearance techniques, inhaled antibiotics and long-term macrolide therapy in bronchiectasis patients. […] The goals of therapy for bronchiectasis are to reduce the symptom burden, improve quality of life, reduce exacerbations and prevent disease progression. […] We review the pharmacological and non-pharmacological treatments that can improve mucociliary clearance, reduce airway inflammation and tackle airway infection, the key pathophysiological features of bronchiectasis. […] The marked abnormalities in the mucus of bronchiectasis patients mandate that airway clearance is an absolute necessity in bronchiectasis management. […] Consequently, international guidelines recommend all patients with bronchiectasis receive instruction in airway clearance techniques taught by respiratory physiotherapists.

• #1 Bronchiectasis – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/treatment

  The goals of treatment are to: […] These goals are achieved through medicines, hydration, and chest physical therapy (CPT). If bronchiectasis occurs in only a section of the lungs or if you have a lot of bleeding, your healthcare provider may recommend surgery. If bronchiectasis is widespread and causes respiratory failure, your provider may recommend oxygen therapy. […] Oral antibiotics are often used as the main treatment for repeated lung infections ( exacerbations ) due to bronchiectasis. The normal course of treatment is 14 days. […] For hard-to-treat infections, your healthcare provider may prescribe intravenous (IV) antibiotics. […] To reduce risk of exacerbations, inhaled antibiotics may be used if you have a chronic infection. […] Your healthcare provider may prescribe expectorants and mucus thinners to help you cough up mucus.

• #1 Treating and Managing Bronchiectasis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/treating-and-managing

  The goal of bronchiectasis treatment is to treat any underlying conditions, prevent lung infections, remove excess mucus, and prevent flare-ups, also called exacerbations. This is done with a combination of medication, hydration and chest physical therapy. Oxygen therapy may be recommended to raise low blood oxygen levels. Surgery may be recommended in extreme situations where the bronchiectasis is isolated to a section of lung or there is excessive bleeding. […] Antibiotics are the most common treatment for bronchiectasis. Oral antibiotics are suggested for most cases, but harder to treat infections may require intravenous (IV) antibiotics. […] Mucus thinning medication and expectorants may be prescribed to help you cough up mucus. Expectorants help loosen mucus in the lungs. Mucus thinning medications are often given through a nebulizer, where it is mixed with hypertonic saline solution, turned into a mist, and inhaled deep into the lungs.

• #1 Bronchiectasis management in adults: state of the art and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11211698/

  Long-term suppressive use of inhaled antibiotics has been the most actively investigated therapeutic agent strategy for bronchiectasis in clinical trials. […] Macrolide therapy is highly effective in reducing the frequency of exacerbations in bronchiectasis, believed to be due to its anti-inflammatory properties. […] Inhaled corticosteroids (ICS) are not universally endorsed by the international guidelines. […] A survey of over 700 European patients with bronchiectasis found that 70% of patients described breathlessness as either difficult or very difficult. […] Bronchiectasis exacerbations are watershed events in the natural history of the disease. […] Bronchiectasis guidelines recommend antibiotics as the mainstay of treatment for bronchiectasis exacerbation. […] The fundamental goals of bronchiectasis treatment are to lessen the symptom burden, improve HRQoL, reduce exacerbations and prevent disease progression.

• #1 Bronchiectasis management in adults: state of the art and future directions

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11211698/

  A recent RCT provided more long-term evidence for airway clearance. […] Overall, studies have shown mixed results regarding which airway clearance technique is superior. […] Inhaled dry mannitol powder was examined in two double-blind RCTs. […] Exercise improves shortness of breath, reduces fatigue and raises endurance in bronchiectasis patients. […] The rational for short- and long-term antibiotics is based on two scientific findings: 1) high airway bacterial loads correlate with airway and systemic inflammation and a greater risk of exacerbation in bronchiectasis patients, and 2) short- and long-term antibiotic treatments are associated with reductions in bacterial load and airway and systemic inflammation. […] The European Respiratory Society (ERS) and British Thoracic Society (BTS) guidelines for adult bronchiectasis suggest that patients with a new isolation of P. aeruginosa should be offered eradication antibiotic treatment, despite low quality of evidence.

• #1 Treating and Managing Bronchiectasis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/bronchiectasis/treating-and-managing

  Other medications may be recommended including bronchodilators which relax the muscles around your airways to help open the airways and make breathing easier. Inhaled corticosteroids may be used to help treat inflammation in your airways. […] You should also work closely with your healthcare provider to determine healthy habits that will help manage your symptoms and decrease the risk of flare-ups. […] Take antibiotics as prescribed by your healthcare provider during flare-ups.

• #1 Airway Clearance and Bronchiectasis

  https://respiratory-therapy.com/products-treatment/monitoring-treatment/therapy-devices/airway-clearance-bronchiectasis/

  The following are airway clearance techniques available for the treatment of bronchiectasis: cough and huffing; postural drainage and percussion/vibrations Active Cycle of Breathing (ACBT); Autogenic Drainage (AD); Positive Expiratory Pressure (PEP); Oscillating PEP; and High Frequency Chest Wall Oscillation (HFCWO). All techniques should be adapted to suit the personal needs of a patient, and clinicians should consider the underlying pathology when prescribing a treatment plan. […] Airway clearance therapy can yield positive benefits for bronchiectasis patients. Airway clearance therapy is a key part of daily management of bronchiectasis, maximizing the opportunity to clear secretions and minimize symptoms of coughing throughout the course of a day. […] The prevention of infection is a key goal of airway clearance therapy as it can exacerbate bronchiectasis and endanger a persons health.

• #1 Airway Clearance and Bronchiectasis

  https://respiratory-therapy.com/products-treatment/monitoring-treatment/therapy-devices/airway-clearance-bronchiectasis/

  Often overshadowed by asthma and COPD, hospital admissions for bronchiectasis are estimated to cost the US healthcare system as much as $1.4 billion annually. The use of airway clearance therapy can be a key part of the daily management of the disease. […] The effective treatment of this condition can better a patients quality of life and improve associated symptoms, and respiratory therapists (RTs) can play an integral role in the care of bronchiectasis patients. […] The treatment of bronchiectasis focuses on controlling infections and secretions, relieving obstructions in the airway, sometimes surgically removing affected portions of the lung, embolization, and preventing complications. Early and effective treatment can significantly reduce complications, such as low blood oxygen levels and respiratory failure. Patients with bronchiectasis who have a chronic productive cough and/or evidence of mucus plugging on HRCT scanning should be taught airway clearance techniques by a clinician. The duration and frequency of the airway clearance technique should be specific to the needs of the individual, but generally it should be performed for 20 to 30 minutes once or twice daily.

• #1 Treatment – Lung Foundation Australia

  https://lungfoundation.com.au/patients-carers/conditions/bronchiectasis/treatment/

  Although there is no current cure for bronchiectasis, early treatment is important to help improve how you feel, keep the condition well managed, and maintain normal lung function. […] Many patients manage their symptoms with an airway clearance routine (a cornerstone of bronchiectasis management) along with exercise, without the need for specific medications except during flare-ups. […] Clearing mucus/sputum from the chest every day is very important to decrease the risk of flare-ups. […] Pulmonary rehabilitation is an exercise and education program provided by specially trained health professionals that teaches you the skills needed to manage your symptoms and to stay well and out of hospital. […] Quitting smoking, being physically active, eating well, getting plenty of rest, enjoying friends, family and hobbies, practicing relaxation techniques, joining a support group and keeping a positive attitude, are all things you can do to support your health and manage your bronchiectasis.

• #1 Bronchiectasis – Treatment | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/bronchiectasis/treatment

  Your healthcare provider may prescribe other medicines, depending on your symptoms or other conditions you may have. […] Drinking plenty of fluid, especially water, helps prevent airway mucus from becoming thick and sticky. […] Chest physical therapy (CPT) is also known as physiotherapy, chest clapping, and percussion. […] Airway clearance techniques help loosen lung mucus so it can be cleared, reducing infections and improving breathing. […] Oxygen therapy and surgery are also options. Your healthcare provider may recommend surgery if no other treatments have helped. […] In very rare instances of severe bronchiectasis, your provider may recommend that you receive a lung transplant to provide you with a healthy set of lungs.

• #1 Bronchiectasis | QGDS – CCM

  https://www.ccm.health.qld.gov.au/management-of-diagnosed-conditions/bronchiectasis

  Management involves improving mucus clearance, while reducing airway bacterial colonisation, inflammation, and structural damage by: […] Support patient self-management […] Discuss bronchiectasis and: […] Airway clearance technique […] Main therapy to clear excess lung secretions to improve ventilation and reduce hospital presentations […] Long-term antibiotics to reduce exacerbation frequency and symptoms in adults […] Azithromycin prophylaxis in children with non-cystic fibrosis (non-CF) bronchiectasis or chronic suppurative lung disease (CSLD) […] Consult specialist and hospitalise any patient with severe exacerbations with chronic P. aeruginosa colonisation or those in MRSA prevalent communities […] Smoking cessation medicines […] Supplemental oxygen therapy may be used if there is evidence of hypoxic respiratory failure (SpO2 90% or PaO2 65mmHg) […] Treat exacerbations of bronchiectasis for 14 days […] If response is rapid and culture is negative for P aeruginosa, shorten duration to 10 days […] For first or new isolation of P. aeruginosa colonisation without exacerbation […] For acute exacerbations without P. aeruginosa colonisation

• #1 Medical Therapy for Bronchiectasis | NYU Langone Health

  https://nyulangone.org/conditions/bronchiectasis/treatments/medical-therapy-for-bronchiectasis

  Doctors at NYU Langone recommend manual techniques and devices to help open the airways and reduce mucus and inflammation in people with bronchiectasis. […] A therapy known as airway clearance can help prevent thick mucus from building up. One technique, known as manual chest therapy, or percussion, involves a rhythmic clapping of the chest to break up lung mucus so it becomes easier to cough up. […] Doctors may also recommend a mucus-clearing device. Breathing into the device causes a fluttering or vibration of the airways, loosening mucus and making it easier to cough up. […] If bronchiectasis is severe, it can prevent you from getting enough oxygen. If this occurs, your NYU Langone pulmonologist may recommend oxygen therapy. Oxygen is delivered to the lungs through small plastic tubes that are placed in the nostrils, or through a face mask that fits over the nose and mouth. Oxygen canisters are portable and are often available through medical suppliers. […] Doctors may initially prescribe oxygen therapy for use in situations that demand more oxygen, such as exercise or sleep. If symptoms worsen, your doctor may recommend continuous oxygen therapy, which is used around the clock.

• #1

  https://www.nhs.uk/conditions/bronchiectasis/treatment/

  The damage to the lungs associated with bronchiectasis is permanent, but treatment can help prevent the condition getting worse. […] In most cases, treatment involves a combination of medicine, exercises you can learn, and devices to help clear your airways. Surgery for bronchiectasis is rarely required. […] In some cases, medicines to make breathing or clearing your lungs easier may be prescribed. […] If you experience a worsening of symptoms because of a bacterial infection (infective exacerbation), you’ll need to be treated with antibiotics. […] If you have 3 or more infective exacerbations in any 1 year or your symptoms during an infective exacerbation were particularly severe, it may be recommended that you take antibiotics on a long-term basis. […] Surgery is only recommended for brochiectasis if: it’s only affecting a single section of your lung, your symptoms are not responding to other treatment, you do not have an underlying condition that could cause bronchiectasis to come back.

• #1 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality in patients of any age. […] In general, surgery should be reserved for patients who have focal disease with localized area of bronchiectasis that is poorly controlled by antibiotics. […] Single- or double-lung transplantation has been used as treatment of severe bronchiectasis, predominantly when related to CF. […] Brensocatib, an inhibitor of dipeptidyl peptidase 1 (DPP1), a lysosomal cysteine protease that is responsible for NSP activation in bone marrow during the neutrophil maturation cycle, is being studied as a novel agent for reducing exacerbations in patients with bronchiectasis.

• #1 Bronchiectasis and Its Treatment – Prof. Dr. Semih Halezeroğlu

  https://semihhalezeroglu.com.tr/en/bronchiectasis-and-its-treatment/

  Bronchiectasis is typically diagnosed based on the patients symptoms and physical examination findings. […] Treated initially with antibiotics and bronchodilators. […] Postural drainage is used to facilitate bronchial clearance by encouraging patients to cough out sputum in specific positions, preferably in the morning. […] Respiratory physiotherapy strengthens the lungs and increases their capacity. […] If treatment is ineffective, surgery may be necessary. […] Lung transplantation may be required in cases where both lungs are severely affected. […] If it cannot be treated with medications […] If the patients quality of life deteriorates […] In cases of coughing up blood […] If there is inflammation in the lung cavity […] If frequent hospitalizations are required. […] The preferred surgical method for bronchiectasis is the closed surgery technique called SINGLE PORT VATS.

• #1 Bronchiectasis Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bronchiectasis-treatment/

  Bronchiectasis exacerbations are currently understood to be caused by pulmonary infections, typically bacterial, but also non-tuberculosis mycobacterial, viral, and fungal. […] This summary will not address the treatment of acute exacerbations of bronchiectasis due to cystic fibrosis, allergic bronchopulmonary aspergillosis, and non-tuberculosis mycobacteria. […] A 14-day course of antibiotics is usual, although shorter courses may be used for milder exacerbations. […] Empiric antibiotics should be started based on previous sputum microbiology. […] Sputum culture and sensitivity should be acquired before initiation of therapy to guide antibiotic choice in the case of poor response to empiric treatment. A blood culture is recommended for patients with respiratory distress or a fever ≥38°C.

• #1 Treatment – Patient Priorities

  https://www.europeanlunginfo.org/bronchiectasis/treatment/

  Infection can be treated by […] Lung damage can be treated by […] Other important considerations are to avoid smoking and to treat the underlying cause of bronchiectasis if this has been identified. […] Bronchiectasis is not caused by smoking, but symptoms can be made much worse by smoking and the condition will progress more rapidly unless you are able to stop. […] Long term antibiotic treatment is given to individuals who have a lot of exacerbations or very severe symptoms. Taking an antibiotic regularly helps to suppress the bacteria that live in the lungs and prevent chest infections. […] Inhaled antibiotics […] Occasionally treatment will be given by injection instead of as tablets. This is usually because oral antibiotics have not worked, or because the bacteria causing the infection is resistant to all of the antibiotics that are available orally.

• #1 Key Areas of Research and Emerging Therapies In Bronchiectasis Treatment

  https://www.ajmc.com/view/key-areas-of-research-and-emerging-therapies-in-bronchiectasis-treatment

  Many new experimental bronchiectasis therapies are under investigation with increased pharmaceutical industry interest. One medication class is dipeptidyl-peptidase (DPP-1) inhibitors which block neutrophil serine protease activation (like neutrophil elastase) without impairing other neutrophil functions. Neutrophil elastase directly causes bronchiectasis inflammation and tissue damage. A DPP-1 inhibitor phase 2 trial demonstrated reduced exacerbations. Multiple similar agents are under study. […] Research into bronchiectasis endotypes (underlying characteristics) also shows promise for precision therapy approaches. About 20% of bronchiectasis patients have eosinophil-predominant inflammation. Some case reports suggest possible benefits from asthma biologic medications in this subgroup. Also, the historical practice of avoiding inhaled corticosteroids due to infection risks like nontuberculous mycobacteria is being reevaluated given the potential advantages of treating eosinophilic inflammation.

• #1 Current Treatment Options For Bronchiectasis

  https://www.ajmc.com/view/current-treatment-options-for-bronchiectasis

  The main bronchiectasis management goals are improving quality of life, decreasing cough/sputum burden, reducing exacerbation frequency, and preventing complications like hemoptysis and respiratory failure. Regimens are highly patient-specific depending on disease severity. Patients with mild symptoms may only require airway clearance without extensive treatment burden. […] For mild disease, starting with nonpharmacological airway clearance devices alone often helps control symptoms. Handheld oscillatory positive expiratory pressure devices facilitate mucus clearance by loosening and sheer forces during forced exhalation maneuvers. Some patients improve on this alone without progression. If more intensive therapy is warranted/desired, adding inhaled hypertonic saline prior to airway clearance sessions can hydrate airways, further enhancing mucus clearance.

• #1 How is bronchiectasis treated? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiectasis/how-bronchiectasis-treated

  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. […] Our bronchiectasis Patient Passport best care checklist can help. Its a simple tool that only takes around five minutes to complete. It gives you a personalised report about your bronchiectasis care, including things you could ask your healthcare professional at your review about the care youre receiving.

• #1 Center for Bronchiectasis Care | Pulmonary, Critical Care and Sleep Medicine

  https://health.uconn.edu/pulmonary/center-for-bronchiectasis-care/

  Bronchiectasis is a serious and chronic disease that warrants specialized care. It is characterized by enlargement, inflammation and chronic infection of the bronchi (the tubes that conduct air from the windpipe to the lung.) This can make regular breathing difficult and cause continued damage to the airways. […] At the UConn Center for Bronchiectasis Care, we offer a comprehensive program to diagnose, evaluate and treat patients with bronchiectasis. […] All patients will see a pulmonary specialist with expertise in caring for patients with bronchiectasis. Because clearance of the excessive mucus is often integral to the treatment and management of bronchiectasis, each patient will have the opportunity to meet with a respiratory therapist. […] Several therapies have been shown to improve quality of life in bronchiectasis patients. The mainstays of treatment include techniques for clearing mucus and the careful use of antibiotics. Newer therapies are being studied and the Center hopes to be able to offer promising experimental therapies as they become available.

• #1 Medical management of bronchiectasis – O’Donnell – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/24453/18556

  Surgical resection is a viable option for some patients with bronchiectasis, either to remove the most involved part of the lung or a focal area of disease. […] The medical management of bronchiectasis includes a careful confirmation of the diagnosis based on clinical and computed tomography findings. Patients should have a systematic evaluation of potential causes of bronchiectasis, particularly to assess whether they have a treatable underlying condition which might alter the course of their lung disease. Treatment should be approached in a step wise fashion based on severity of disease and microbiologic findings. A multi-modality approach to treatment is important, adding therapies as dictated by the clinical course.

• #1 Bronchiectasis – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/lung-diseases/bronchiectasis

  Bronchiectasis can’t be cured, but it can be treated. […] Treatment is based on clearing mucus from your lungs, preventing infections and reducing inflammation. With proper treatment, most people with this disease live a normal life. […] One mainstay of treatment, clearing mucus out of the lungs, is often compared to „forcefully emptying the last remnants from a ketchup bottle.” It combines postural drainage (placing the head lower than the chest) with chest percussion (thumping over the lungs to dislodge pooled secretions). […] Many patients also benefit from frequent antibiotic use, often delivered directly to the lungs with a nebulizer, a drug delivery device that transforms medications into a mist that is then inhaled into the lungs. […] Your doctor may also prescribe medications to dilute mucus, dilate your airways and decrease inflammation.

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  A crucial goal of bronchiectasis treatment is to reduce the frequency of pulmonary exacerbations. A high frequency of exacerbation has been associated with worse outcomes including decline in lung function, increase anxiety, worse health related quality of life, increase in hospitalizations, and increased mortality. […] The aim is to achieve symptom reduction and improvement in quality of life, preservation of lung function, and reduction of overall morbidity and mortality. […] The treatment approach focuses on targeting the components of the vicious cycle concept of bronchiectasis; mainly on preventing or controlling acute and chronic bronchial infections, enhancing mucociliary clearance, and minimizing the effects of structural lung disease. […] Additionally, management of underlying conditions, which may include the use of intravenous immunoglobulin or intravenous alpha1-antitrypsin (AAT) therapy, is essential to the overall treatment.

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Thus, antibiotic therapy has been always a centerpiece in management of bronchiectasis to prevent and treat exacerbation. […] In acute exacerbations, broad-spectrum antibacterial agents are generally preferred. […] Acceptable choices for the outpatient who is mild to moderately ill include any of the following: Amoxicillin, Tetracycline, Trimethoprim-sulfamethoxazole, A newer macrolide (ie, azithromycin or clarithromycin), A second-generation cephalosporin, A fluoroquinolone. […] In general, ESR recommends the duration of antibiotic therapy to be 14 days. […] For patients with moderate-to-severe symptoms, parenteral antibiotics, such as an aminoglycoside (gentamicin, tobramycin) and an antipseudomonal synthetic penicillin, a third-generation cephalosporin, or a fluoroquinolone, may be indicated.

• #2 Bronchiectasis Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bronchiectasis-treatment/

  Bronchiectasis exacerbations are currently understood to be caused by pulmonary infections, typically bacterial, but also non-tuberculosis mycobacterial, viral, and fungal. […] This summary will not address the treatment of acute exacerbations of bronchiectasis due to cystic fibrosis, allergic bronchopulmonary aspergillosis, and non-tuberculosis mycobacteria. […] A 14-day course of antibiotics is usual, although shorter courses may be used for milder exacerbations. […] Empiric antibiotics should be started based on previous sputum microbiology. […] Sputum culture and sensitivity should be acquired before initiation of therapy to guide antibiotic choice in the case of poor response to empiric treatment. A blood culture is recommended for patients with respiratory distress or a fever ≥38°C.

• #2 Bronchiectasis Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bronchiectasis-treatment/

  It is recommended that patients already taking long-term antibiotics continue to do so throughout treatment if possible. […] Afebrile, clinically stable patients can be treated as outpatients with oral antibiotics. […] Intravenous antibiotics if severe exacerbations (see criteria for admission below), resistant organisms, or poor response to oral antibiotics (typically patients with Pseudomonas infection). […] Consider testing for viral infection in an acute exacerbation of bronchiectasis. Exacerbations instigated by influenza should be treated with appropriate antiviral therapy. […] There is no evidence to recommend the use of systemic corticosteroids in the treatment of acute bronchiectasis exacerbations, although they are commonly used. […] Increased airway clearance therapy (respiratory physiotherapy), including postural drainage and manual techniques. […] Pre-existing maintenance therapy should be continued throughout the duration of treatment (long-term antibiotic therapy, airway clearance therapy, mucoactive agents, pulmonary rehabilitation, and comorbidity management.)

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  It is important to note that the data supporting eradication treatment is limited. […] ERS guidelines for long-term antibiotic treatment for adults with bronchiectasis who have three or more exacerbations per year. […] For patient who do not have PA infection, a macrolide antibiotic (azithromycin or erythromycin) can be used. […] For patients with chronic PA in infection, inhaled anti-pseudomonal antibiotics are recommended. […] For patients who have chronic PA infection with contraindication to inhaled antibiotic and those who continue to have high exacerbation frequency despite inhaled antibiotic, macrolide therapy is recommended as an alternative to or in addition to inhaled antibiotic. […] Surgery is an important adjunct to therapy in some patients with advanced or complicated disease.

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Infection with Mycobacterium avium complex (MAC) provides special treatment challenges. […] For the treatment of MAC in the setting of bronchiectasis, the American Thoracic Society recommends a 3- to 4-drug treatment regimen with clarithromycin, rifampin, ethambutol, and possibly streptomycin that is continued until the patient’s culture results are negative for 1 year. […] The ERS guidelines suggest providing long-term mucoactive therapy (at least 3 months) for adult bronchiectasis patients who have difficulty in sputum expectoration and experience poor quality of life, especially when standard airway clearance methods have not successfully controlled their symptoms. […] ERS guidelines recommend that adults with bronchiectasis with a new isolation of P. aeruginosa should be offered eradication antibiotic treatment.

• #2 Bronchiectasis: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/21144-bronchiectasis

  Macrolides are drugs that treat infections and inflammation at the same time. […] Expectorant and mucolytics are medications that thin mucus and help you cough it out. These are available over-the-counter or by prescription. […] Physical therapy. Postural draining and chest percussion therapy can help loosen and remove mucus. Breathing exercises can help open up your airways. […] Medical devices. Oscillating positive expiratory pressure (PEP) devices and percussive vests break up and pull mucus out from your lungs. […] If bronchiectasis is caused by an underlying condition, treating that condition may help your symptoms. If you have a small area of bronchiectasis, your provider might recommend surgery, though this is rare.

• #2 Bronchiectasis Medication: Antibiotics, Inhaled Beta Agonist, Inhaled Corticosteroids, Expectorants

  https://emedicine.medscape.com/article/296961-medication

  No specific medical therapy exists for the treatment of bronchiectasis. Pharmacologic therapy focuses on the treatment of infectious exacerbations that these patients commonly experience, most often in the form of an acute bronchitis-type syndrome. […] The most widely accepted and commonly used medications in the treatment of acute infectious processes associated with bronchiectasis include antibiotics, beta-agonists, inhaled corticosteroids, and expectorants. […] These are the mainstays of treatment of patients with bronchiectasis and infectious exacerbations. […] The choice of antibiotic is provider dependent, but, in general, the antibiotic chosen should have a reasonable spectrum of coverage, including the most common gram-positive and gram-negative organisms. […] Inhaled beta-agonists are routinely used in patients with bronchiectasis for multiple reasons.

• #2 Airway Clearance and Bronchiectasis

  https://respiratory-therapy.com/products-treatment/monitoring-treatment/therapy-devices/airway-clearance-bronchiectasis/

  Often overshadowed by asthma and COPD, hospital admissions for bronchiectasis are estimated to cost the US healthcare system as much as $1.4 billion annually. The use of airway clearance therapy can be a key part of the daily management of the disease. […] The effective treatment of this condition can better a patients quality of life and improve associated symptoms, and respiratory therapists (RTs) can play an integral role in the care of bronchiectasis patients. […] The treatment of bronchiectasis focuses on controlling infections and secretions, relieving obstructions in the airway, sometimes surgically removing affected portions of the lung, embolization, and preventing complications. Early and effective treatment can significantly reduce complications, such as low blood oxygen levels and respiratory failure. Patients with bronchiectasis who have a chronic productive cough and/or evidence of mucus plugging on HRCT scanning should be taught airway clearance techniques by a clinician. The duration and frequency of the airway clearance technique should be specific to the needs of the individual, but generally it should be performed for 20 to 30 minutes once or twice daily.

• #2 Airway Clearance Therapy for Bronchiectasis | Respiratory Therapy

  https://respiratory-therapy.com/disorders-diseases/chronic-pulmonary-disorders/chronic-diseases/airway-clearance-therapy-for-bronchiectasis/

  Airway clearance is essential to improving the health and well-being of patients who have bronchiectasis. […] With the retained secretions that are thick and often copious, airway clearance is a primary therapy that is needed in bronchiectasis. […] Overall treatment goals should be to reduce symptoms, improve quality of life, preserve lung function, and reduce overall morbidity and mortality. […] There are many approaches to help clear secretions, involving inhaled medications, various breathing patterns, chest physiotherapy, and use of different devices. […] Non-pharmacologic approaches to clearing airway secretions using devices has been available for many years and many devices are available on the market. […] The choice of a technique or device should be based upon frequency and tenacity of phlegm, patient comfort, cost, and the patients ability to use the technique or device with minimal interference to their lifestyle and minimal detriment to coexisting medical conditions.

• #2 Bronchiectasis treatment | Royal Brompton & Harefield hospitals

  https://www.rbht.nhs.uk/our-services/bronchiectasis-treatment

  If we diagnose you with bronchiectasis, we will discuss with you a specific treatment plan. This will be tailored to you personally, based on what will be most beneficial to you. […] Physiotherapy is an important part of managing bronchiectasis. […] We may teach you airway clearance techniques (ACT), which may include postural drainage (PD) exercises. These involve lying on alternate sides and performing breathing exercises which help drain phlegm. […] You should carry out these exercises once or twice a day for at least 20 minutes per session. With regular airway clearance, you will cough up mucus which might otherwise collect in the lungs. This prevents infection and means you are less likely to cough up mucus at other times of the day. […] Exercising in any form also helps the lungs clear mucus and improves general fitness.

• #2 How is bronchiectasis treated? | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/bronchiectasis/how-bronchiectasis-treated

  If you smoke, quitting is the best thing you can do for your health. […] If you get breathless, ask your healthcare professional about pulmonary rehabilitation (PR). […] If you have bronchiectasis, its important to get vaccinated against harmful viruses and infections. […] 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. […] A lung transplant is rarely needed in bronchiectasis. Its for people who have very severe lung disease and no other treatment options. […] 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. […] Make sure you review your treatment with your healthcare professional at least once a year.

• #2 Bronchiectasis Treatment | What to do Post-Diagnosis?

  https://www.nationaljewish.org/conditions/bronchiectasis/overview/treatment

  The management of bronchiectasis is long-term and is directed at: […] Improving the clearance of sputum, also called airway clearance or bronchopulmonary hygiene, […] Treatment of infections, […] Treatment of associated conditions (such as GERD or sinusitis), […] Improving muscle strength and endurance through pulmonary rehabilitation […] Identifying the need for surgical resection of affected segments or lobes of the lung. […] Improved clearance of mucus is the cornerstone of the management of bronchiectasis and includes several components. […] Inhaled medication (bronchodilator and/or inhaled steroid, saline) and/or […] Airway clearance measures (oscillating positive expiratory pressure device, high-frequency chest wall oscillation vest). […] Antibiotics are used to treat bacteria and other infectious organisms causing infection in the lungs in order to improve respiratory symptoms and prevent further damage to the airways.

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Antibiotics and chest physiotherapy are the mainstay modalities. Other modalities (beyond those for specific associated conditions) may include bronchodilators, corticosteroid therapy, dietary supplementation, and oxygen or surgical therapies. […] A crucial goal of bronchiectasis treatment is to reduce the frequency of pulmonary exacerbations. […] The following general measures are recommended: Smoking cessation, Avoidance of second-hand smoke, Adequate nutritional intake with supplementation, if necessary, Immunizations for influenza and pneumococcal pneumonia, Confirmation of immunizations for measles, rubeola, and pertussis. […] Oxygen therapy is reserved for patients who are hypoxemic with severe disease and end-stage complications, such as cor pulmonale. […] Antibiotics have been the mainstay of treatment for more than 40 years.

• #2 Bronchiectasis and exacerbations or “flare ups” – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/bronchiectasis-and-exacerbations-or-flare-ups/

  If you are admitted to hospital and your oxygen levels are low, you will usually be given oxygen, either through a mask on your face or a tube with prongs which sit inside your nose. […] Your doctor may prescribe you an antibiotic which you will take for at least 6 months. The most common antibiotic that is used is called Azithromycin. It is taken three times a week. This antibiotic reduces the inflammation in your airways which allows them to fight off infections more effectively. […] If you have grown pseudomonas in your sputum and are getting frequent flare ups, we may consider prescribing an antibiotic called Colomycin, which is taken through a nebuliser twice a day. […] Occasionally, if the other strategies have been tried and not been successful, your consultant may decide to give you regular courses of intravenous antibiotics every 8-12 weeks to keep you well.

• #2 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Surgical resection for bronchiectasis can be performed with acceptable morbidity and mortality in patients of any age. […] In general, surgery should be reserved for patients who have focal disease with localized area of bronchiectasis that is poorly controlled by antibiotics. […] Single- or double-lung transplantation has been used as treatment of severe bronchiectasis, predominantly when related to CF. […] Brensocatib, an inhibitor of dipeptidyl peptidase 1 (DPP1), a lysosomal cysteine protease that is responsible for NSP activation in bone marrow during the neutrophil maturation cycle, is being studied as a novel agent for reducing exacerbations in patients with bronchiectasis.

• #2 Surgical Treatment of Bronchiectasis – Saint John’s Cancer Institute Blog

  https://www.saintjohnscancer.org/blog/surgical-treatment-of-bronchiectasis/

  Treatment for bronchiectasis usually begins with antibiotics and macrolides, which are used to reduce inflammation in the bronchi. […] However, when the patient is no longer responding to these various medications, surgical treatment will most likely be recommended. […] Surgical treatment of bronchiectasis usually uses pulmonary resection, or the removal of part of the lung. […] Most times, it can be surgically performed through the use of a video-assisted thoracoscope. […] However, in cases of diffuse bronchiectasis, especially in those with cystic fibrosis, a bilateral lung transplant is usually the only surgical option. […] Ideal surgical candidates are those individuals who exhibit localized disease, have failed to control their condition with medications, and who have recurring symptoms that negatively affect their quality of life.

• #2 Surgical Treatment of Bronchiectasis – Saint John’s Cancer Institute Blog

  https://www.saintjohnscancer.org/blog/surgical-treatment-of-bronchiectasis/

  In order to determine if you are an ideal candidate for surgery, Dr. McKenna will perform a pre-surgical assessment. […] During the surgery, the patient will be anesthetized using standard anesthetic technique with single-lung ventilation. […] Most surgeries begin with a bronchoscopy to clear the airway and optimize ventilation. […] Then, depending on the nature of the procedure being performed, pulmonary resection will begin either through an thoracotomy (open) approach or via a video-assisted thoracoscopic approach. […] If you have been diagnosed with bronchiectasis or believe that you may be experiencing symptoms of bronchiectasis and would like more information, schedule a consultation with Dr. McKenna today.

• #2 Bronchiectasis and exacerbations or “flare ups” – North Tees and Hartlepool NHS Foundation Trust

  https://www.nth.nhs.uk/resources/bronchiectasis-and-exacerbations-or-flare-ups/

  In addition to clearing the phlegm regularly, stopping smoking is the single most important thing you can do. This helps reduce the inflammation in your airways, which cuts down the amount of mucous and phlegm that is being produced. […] Exercise is really important. People with bronchiectasis can become more breathless because of the narrowing in the airways. […] When you notice the symptoms of a flare up, we ask you to increase how often you do your coughing and breathing techniques. This can be up to three or four times a day. […] You will usually be given a course of antibiotics for 10 – 14 days. If you are well enough, this will be given as tablets. […] When you are admitted to hospital, you may also be given a regular nebuliser. This will usually be salty water (a much less potent version of the one described previously) to help make your phlegm runnier and easier to cough up.

• #2 Bronchiectasis: diagnosis, treatment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/bronchiectasis-diagnosis-treatment-and-management

  Several studies have shown that improved bacterial clearance is seen in patients who receive targeted antibiotics. Therefore, before starting antimicrobial therapy, a sputum sample should be sent for culture and sensitivity. If no microbiology is available, BTS guidelines recommend patients should initially be started on amoxicillin 500mg three-times daily (TDS) oral or clarithromycin 500mg twice daily (BD) oral (if they are allergic to penicillin). If patients are not responding to the empirical antibiotics, the sputum culture results and in vitro sensitivity test results should be reviewed. Higher doses of prolonged antibiotics are needed in patients who have purulent sputum and severe bronchiectasis. […] According to BTS guidelines, long-term antibiotics are considered in patients who have three or more exacerbations in a year requiring antibiotics. If patients are not having multiple exacerbations, but recover slowly from exacerbations, they can also be considered for long-term antibiotic therapy.

• #2 Treatment – Lung Foundation Australia

  https://lungfoundation.com.au/patients-carers/conditions/bronchiectasis/treatment/

  Although there is no current cure for bronchiectasis, early treatment is important to help improve how you feel, keep the condition well managed, and maintain normal lung function. […] Many patients manage their symptoms with an airway clearance routine (a cornerstone of bronchiectasis management) along with exercise, without the need for specific medications except during flare-ups. […] Clearing mucus/sputum from the chest every day is very important to decrease the risk of flare-ups. […] Pulmonary rehabilitation is an exercise and education program provided by specially trained health professionals that teaches you the skills needed to manage your symptoms and to stay well and out of hospital. […] Quitting smoking, being physically active, eating well, getting plenty of rest, enjoying friends, family and hobbies, practicing relaxation techniques, joining a support group and keeping a positive attitude, are all things you can do to support your health and manage your bronchiectasis.

• #2 Novel Therapies for Non-Cystic Fibrosis Bronchiectasis Treatment

  https://www.delveinsight.com/blog/non-cystic-fibrosis-bronchiectasis-treatment

  Inhaled corticosteroids (ICS) have also been investigated in NCFB, and studies have been conducted to compare the use of high-dose ICS and medium-dose ICS. Nebulized 7% hypertonic saline is also considered safe and effective in addressing sputum retention and improving lung function. […] The use of macrolides for non-cystic fibrosis bronchiectasis treatment has become common in recent years due to several characteristics, their anti-inflammatory effects, ability to decrease mucus production, and well-known effect on Gram-positive cocci and atypical pathogens. Recent evidence demonstrates that long-term treatment with macrolides, particularly azithromycin, significantly reduced the incidence of NCFB exacerbations improving quality of life. […] The non-cystic fibrosis bronchiectasis treatment market faces several challenges and concerns that hinder the development of effective treatments. There are no specific NCFB therapies approved by the FDA that target the causes of NCFB, and the available off-label non-cystic fibrosis bronchiectasis treatments primarily focus on managing symptoms and preventing exacerbations.

• #2 Current Treatment Options For Bronchiectasis

  https://www.ajmc.com/view/current-treatment-options-for-bronchiectasis

  For frequent exacerbators, adding chronic low-dose macrolide antibiotic therapy reduces exacerbations by anti-inflammatory effects. Screening for nontuberculous mycobacterial infection beforehand is mandatory to prevent inducing resistance. Inhaled antibiotics help for chronic gram-negative infections, improving bacterial clearance. […] For newly detected Pseudomonas infection, attempting eradication therapy is supported. This entails intensive combination inhaled and oral antibiotic treatment, aiming to definitively clear the organism and prevent chronic infection, which portends worse outcomes. Though evidence quality is modest, eradication can succeed in delaying chronic infection a year or more. […] In summary, bronchiectasis management is highly personalized based on disease severity and exacerbation frequency. Mainstays are airway clearance and treating exacerbations. Chronic macrolide therapy, inhaled antibiotics, and attempting Pseudomonas eradication provide further specialized options for more difficult cases.

• #2 Bronchiectasis: diagnosis, treatment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/bronchiectasis-diagnosis-treatment-and-management

  The BTS guidelines recommend that certain patients with bronchiectasis should have regular follow up in secondary care in view of their poor prognosis. These include: Patients with recurrent exacerbations — three or more per year; Patients with deteriorating bronchiectasis; Patients with bronchiectasis associated with rheumatoid arthritis, immune deficiency, inflammatory bowel disease and primary ciliary dyskinesia; Patients with repeated isolates of NTM; Patients with methicillin-resistant S. aureus (MRSA) colonisation; Patients with chronic P. aeruginosa infection with two or more isolates, while stable in the last 12 months; Patients with ABPA; Patients on prophylactic antibiotic therapy; Patients with advanced disease and those requiring transplantation. […] Physiotherapy is an essential part of treatment in bronchiectasis. It helps with expectoration of bronchopulmonary secretions and improves effective ventilation. Various airway clearance techniques can be used. In the UK, the active cycle breathing technique is the commonest technique, sometimes used in combination with postural drainage and manual techniques. Patients are encouraged to be as independent as possible in doing their own physiotherapy.

• #2 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  While there is little evidence to support the use of antibiotics in acute exacerbations of bronchiectasis, there is general consensus that they should be used. […] In patients with significant disability or a severe reduction in FEV1 (40% predicted) regular clinical review should include an assessment of suitability for domiciliary oxygen therapy. […] In selected patients with severe bronchiectasis lung transplantation also has a role. […] Palliative care focusing on symptomatic management, particularly relating to shortness of breath, anxiety and sputum production, can be invaluable in improving quality of life. […] The management of bronchiectasis is complicated, multifaceted and requires the coordination of a broad range of healthcare providers.

• #2 Bronchiectasis Information | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/lung-breathing-disorders/our-services/bronchiectasis/about-bronchiectasis

  Bronchiectasis is a chronic lung condition, meaning there is currently no cure. Treatment focuses on managing symptoms and limiting flare-ups to improve quality of life. […] Bronchiectasis treatments focus on eliminating/controlling infections and clearing mucus to make it easier to breathe. Some treatments are used for daily maintenance, while others help during flare-ups. Treatment will vary based on the underlying cause. Options include: […] Current clinical trials explore new treatment options, including new medical therapies to target NTM infections. […] The outlook for people with bronchiectasis has improved dramatically over the past few decades. Working with a specialist to develop an individualized treatment can help manage symptoms and dramatically improve quality of life. […] The Bronchiectasis Center at Columbia University Irving Medical Center/NewYork-Presbyterian (CUIMC/NYP) is a leading site for comprehensive diagnosis and treatment for all types of bronchiectasis. The center uses a multidisciplinary approach to develop personalized therapy plans for each patient’s unique condition.

• #2 Bronchiectasis: Causes, Symptoms, Treatment & Prevention

  https://my.clevelandclinic.org/health/diseases/21144-bronchiectasis

  Bronchiectasis cant be cured but can be managed with treatment. […] Healthcare providers treat bronchiectasis by clearing mucus and managing infections. Depending on the severity of your condition, your provider might prescribe medication or physical therapy. You may also use medical devices that help get rid of mucus. […] Bronchiectasis treatments help get rid of infected mucus, kill bacteria and decrease inflammation. They include: […] Antibiotics can treat infections caused by bacteria. You can take antibiotics in pill form, but if you have a severe infection, a provider will use an IV to give you antibiotics directly into your bloodstream. […] Providers also often prescribe inhaled antibiotics for bronchiectasis. You may use a nebulizer for inhaled medications, which makes the medicine into a mist that you breathe in.

• #3 Airway Clearance and Bronchiectasis

  https://respiratory-therapy.com/products-treatment/monitoring-treatment/therapy-devices/airway-clearance-bronchiectasis/

  In addition to preventing new infections, airway management is also important in the mobilization of excessive secretions. […] Airway clearance is required as part of a multipronged treatment approach to limiting damage, increasing subjective quality of life by decreasing cough frequency and ultimately reducing morbidity and prolonging life. […] The overall goals of therapy are to improve symptoms, reduce complications, control exacerbations, and to reduce morbidity and mortality. In addition, the management of underlying conditions, which may include the use of intravenous immunoglobulin or intravenous alpha-1 antitrypsin (AAT) therapy, is essential to the overall treatment. […] For people with bronchiectasis, the key goals of airway clearance therapy are to maximize sputum clearance. As a result of this, improvement in quality of life, improvement in lung function, reduction in symptoms of coughing, fatigue and breathlessness, and reducing the frequency of acute infections may be achieved.

• #3 Bronchiectasis: diagnosis, treatment and management – The Pharmaceutical Journal

  https://pharmaceutical-journal.com/article/ld/bronchiectasis-diagnosis-treatment-and-management

  Several studies have shown that improved bacterial clearance is seen in patients who receive targeted antibiotics. Therefore, before starting antimicrobial therapy, a sputum sample should be sent for culture and sensitivity. If no microbiology is available, BTS guidelines recommend patients should initially be started on amoxicillin 500mg three-times daily (TDS) oral or clarithromycin 500mg twice daily (BD) oral (if they are allergic to penicillin). If patients are not responding to the empirical antibiotics, the sputum culture results and in vitro sensitivity test results should be reviewed. Higher doses of prolonged antibiotics are needed in patients who have purulent sputum and severe bronchiectasis. […] According to BTS guidelines, long-term antibiotics are considered in patients who have three or more exacerbations in a year requiring antibiotics. If patients are not having multiple exacerbations, but recover slowly from exacerbations, they can also be considered for long-term antibiotic therapy.

• #3 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Thus, antibiotic therapy has been always a centerpiece in management of bronchiectasis to prevent and treat exacerbation. […] In acute exacerbations, broad-spectrum antibacterial agents are generally preferred. […] Acceptable choices for the outpatient who is mild to moderately ill include any of the following: Amoxicillin, Tetracycline, Trimethoprim-sulfamethoxazole, A newer macrolide (ie, azithromycin or clarithromycin), A second-generation cephalosporin, A fluoroquinolone. […] In general, ESR recommends the duration of antibiotic therapy to be 14 days. […] For patients with moderate-to-severe symptoms, parenteral antibiotics, such as an aminoglycoside (gentamicin, tobramycin) and an antipseudomonal synthetic penicillin, a third-generation cephalosporin, or a fluoroquinolone, may be indicated.

• #3 Medications for Bronchiectasis – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/medications-2/medications-for-bronchiectasis

  A therapeutic trial of pathogen-targeted inhaled antibiotics (Tobramycin / Colistin/ Gentamicin / Ciproflxacin) may be considered in selected patients e.g. those with established Pseudomonas aeruginosa colonisation and frequent exacerbation. […] Long-term oral antibiotics can also be considered for patients with recurrent exacerbations who are otherwise optimally managed, but should not be prescribed routinely (ERS Guidelines 2017). […] Macrolide antibiotics target both inflammation and infection and have been shown to have beneficial clinical effects in patients with bronchiectasis. […] Three major randomised controlled trials in adults and one in children have shown that azithromycin and erythromycin are effective in preventing pulmonary exacerbations (reduced by 40-60%) in patients with bronchiectasis.

• #3 Medications for Bronchiectasis – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/medications-2/medications-for-bronchiectasis

  To treat exacerbations […] As a long term maintenance for suppression of chronic colonisation. […] The use of inhaled antibiotics is challenged by a poor evidence base. […] There are however opportunities for interventions for the individual which should be carefully considered on a case by case basis with close monitoring of clinical effect. The selection of treatments will be based on clinical phenotype based on features including lung function, bronchodilator responsiveness, symptoms, exacerbation frequency and microbial colonisation. […] The optimal eradication regime for Pseudomonas aeruginosa has not been determined however, in practice, two weeks of oral ciprofloxacin is often used. This may be escalated in cases of persistently positive cultures. Specialist advice is recommended.

• #3 Bronchiectasis Treatment Options | Temple Health

  https://www.templehealth.org/services/conditions/bronchiectasis/treatment-options

  Mucus-thinning medication helps to dissolve mucus in the airways so that it can be more easily coughed up. […] Bronchodilators help to open the airways and makes breathing easier. […] Inhaled corticosteroid medications can reduce inflammation of the airways and help prevent exacerbations (flare-ups). […] Though surgery may provide benefits to people with bronchiectasis, it’s usually a last resort for people who have more severe symptoms that are not improved with other treatments. […] Most often, surgical treatment of bronchiectasis involves removing the damaged portion of the lung. […] Doctors may also recommend oxygen therapy. Oxygen therapy can help people with bronchiectasis who have low levels of oxygen in their blood to breathe better.

• #3 Bronchiectasis | QGDS – CCM

  https://www.ccm.health.qld.gov.au/management-of-diagnosed-conditions/bronchiectasis

  Management involves improving mucus clearance, while reducing airway bacterial colonisation, inflammation, and structural damage by: […] Support patient self-management […] Discuss bronchiectasis and: […] Airway clearance technique […] Main therapy to clear excess lung secretions to improve ventilation and reduce hospital presentations […] Long-term antibiotics to reduce exacerbation frequency and symptoms in adults […] Azithromycin prophylaxis in children with non-cystic fibrosis (non-CF) bronchiectasis or chronic suppurative lung disease (CSLD) […] Consult specialist and hospitalise any patient with severe exacerbations with chronic P. aeruginosa colonisation or those in MRSA prevalent communities […] Smoking cessation medicines […] Supplemental oxygen therapy may be used if there is evidence of hypoxic respiratory failure (SpO2 90% or PaO2 65mmHg) […] Treat exacerbations of bronchiectasis for 14 days […] If response is rapid and culture is negative for P aeruginosa, shorten duration to 10 days […] For first or new isolation of P. aeruginosa colonisation without exacerbation […] For acute exacerbations without P. aeruginosa colonisation

• #3 Airway Clearance Therapy for Bronchiectasis | Respiratory Therapy

  https://respiratory-therapy.com/disorders-diseases/chronic-pulmonary-disorders/chronic-diseases/airway-clearance-therapy-for-bronchiectasis/

  Airway clearance is essential to improving the health and well-being of patients who have bronchiectasis. […] With the retained secretions that are thick and often copious, airway clearance is a primary therapy that is needed in bronchiectasis. […] Overall treatment goals should be to reduce symptoms, improve quality of life, preserve lung function, and reduce overall morbidity and mortality. […] There are many approaches to help clear secretions, involving inhaled medications, various breathing patterns, chest physiotherapy, and use of different devices. […] Non-pharmacologic approaches to clearing airway secretions using devices has been available for many years and many devices are available on the market. […] The choice of a technique or device should be based upon frequency and tenacity of phlegm, patient comfort, cost, and the patients ability to use the technique or device with minimal interference to their lifestyle and minimal detriment to coexisting medical conditions.

• #3 Bronchiectasis and Physiotherapy | CUH

  https://www.cuh.nhs.uk/patient-information/bronchiectasis-and-physiotherapy/

  This leaflet is intended to provide information to people who have bronchiectasis, their families and carers. It explains what bronchiectasis is and how physiotherapy can play a part in its treatment. […] Physiotherapy can be very useful in helping to manage the mucus produced in bronchiectasis. A respiratory physiotherapist will assess you in order to devise a personalised management plan for you to perform at home. […] Techniques used to help clear sputum may include: Breathing exercises, such as the Active Cycle of Breathing (ACBT); Use of positioning to target the most affected portions of your lungs which is known as postural drainage; Use of devices such as an Acapella, Aerobika or Flutter. […] You should do these techniques daily, even if you are feeling well, to reduce the chances of mucus getting stuck, causing further infections and leading to more damage. […] If you feel you would like to be seen by a Respiratory Physiotherapist, either when you are well or unwell, then please speak to your doctor.

• #3 Treatment – Lung Foundation Australia

  https://lungfoundation.com.au/patients-carers/conditions/bronchiectasis/treatment/

  Although there is no current cure for bronchiectasis, early treatment is important to help improve how you feel, keep the condition well managed, and maintain normal lung function. […] Many patients manage their symptoms with an airway clearance routine (a cornerstone of bronchiectasis management) along with exercise, without the need for specific medications except during flare-ups. […] Clearing mucus/sputum from the chest every day is very important to decrease the risk of flare-ups. […] Pulmonary rehabilitation is an exercise and education program provided by specially trained health professionals that teaches you the skills needed to manage your symptoms and to stay well and out of hospital. […] Quitting smoking, being physically active, eating well, getting plenty of rest, enjoying friends, family and hobbies, practicing relaxation techniques, joining a support group and keeping a positive attitude, are all things you can do to support your health and manage your bronchiectasis.

• #3 Medical Therapy for Bronchiectasis | NYU Langone Health

  https://nyulangone.org/conditions/bronchiectasis/treatments/medical-therapy-for-bronchiectasis

  Doctors at NYU Langone recommend manual techniques and devices to help open the airways and reduce mucus and inflammation in people with bronchiectasis. […] A therapy known as airway clearance can help prevent thick mucus from building up. One technique, known as manual chest therapy, or percussion, involves a rhythmic clapping of the chest to break up lung mucus so it becomes easier to cough up. […] Doctors may also recommend a mucus-clearing device. Breathing into the device causes a fluttering or vibration of the airways, loosening mucus and making it easier to cough up. […] If bronchiectasis is severe, it can prevent you from getting enough oxygen. If this occurs, your NYU Langone pulmonologist may recommend oxygen therapy. Oxygen is delivered to the lungs through small plastic tubes that are placed in the nostrils, or through a face mask that fits over the nose and mouth. Oxygen canisters are portable and are often available through medical suppliers. […] Doctors may initially prescribe oxygen therapy for use in situations that demand more oxygen, such as exercise or sleep. If symptoms worsen, your doctor may recommend continuous oxygen therapy, which is used around the clock.

• #3 Surgical Treatment of Bronchiectasis – Saint John’s Cancer Institute Blog

  https://www.saintjohnscancer.org/blog/surgical-treatment-of-bronchiectasis/

  Treatment for bronchiectasis usually begins with antibiotics and macrolides, which are used to reduce inflammation in the bronchi. […] However, when the patient is no longer responding to these various medications, surgical treatment will most likely be recommended. […] Surgical treatment of bronchiectasis usually uses pulmonary resection, or the removal of part of the lung. […] Most times, it can be surgically performed through the use of a video-assisted thoracoscope. […] However, in cases of diffuse bronchiectasis, especially in those with cystic fibrosis, a bilateral lung transplant is usually the only surgical option. […] Ideal surgical candidates are those individuals who exhibit localized disease, have failed to control their condition with medications, and who have recurring symptoms that negatively affect their quality of life.

• #3 Bronchiectasis and Its Treatment – Prof. Dr. Semih Halezeroğlu

  https://semihhalezeroglu.com.tr/en/bronchiectasis-and-its-treatment/

  Bronchiectasis is typically diagnosed based on the patients symptoms and physical examination findings. […] Treated initially with antibiotics and bronchodilators. […] Postural drainage is used to facilitate bronchial clearance by encouraging patients to cough out sputum in specific positions, preferably in the morning. […] Respiratory physiotherapy strengthens the lungs and increases their capacity. […] If treatment is ineffective, surgery may be necessary. […] Lung transplantation may be required in cases where both lungs are severely affected. […] If it cannot be treated with medications […] If the patients quality of life deteriorates […] In cases of coughing up blood […] If there is inflammation in the lung cavity […] If frequent hospitalizations are required. […] The preferred surgical method for bronchiectasis is the closed surgery technique called SINGLE PORT VATS.

• #3 Bronchiectasis A guide for primary care

  https://www.racgp.org.au/afp/2012/november/bronchiectasis

  The principles of ongoing management of bronchiectasis are based on the monitoring of severity, reducing progression and complications, early treatment of acute exacerbations, minimising disability, considering transplantation in appropriate patients, managing comorbidities and early utilisation of palliative care services when necessary. […] The management of bronchiectasis is complicated, multifaceted and requires the coordination of a broad range of healthcare providers. […] The role of antibiotics […] While bacteria and fungi are often found in the sputum of people with bronchiectasis, their role in disease development, acute exacerbations and progression is variable. […] An acute exacerbation can be defined as two or more of: increasing cough, shortness of breath, increasing volume/purulence of sputum.

• #3 Bronchiectasis – Pulmonary Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/pulmonary-disorders/bronchiectasis-and-atelectasis/bronchiectasis

  For patients with alpha-1 antitrypsin deficiency: Replacement therapy for those who qualify based on serum levels and FEV1. […] Approaches that have shown promise are under investigation for treatment of bronchiectasis. […] Acute exacerbations are treated with antibiotics, inhaled bronchodilators (particularly if patients are dyspneic or wheezing), increased attempts at mucus clearance using mechanical techniques, treatment of dehydration (if present), humidification, and nebulized saline (and mucolytics for patients with CF). Systemic corticosteroids should not routinely be used to treat exacerbations except in patients with COPD or asthma. Antibiotic choice depends on previous culture results and whether or not patients have CF. […] Initial antibiotics for patients without CF and with no prior culture results should be effective against H. influenzae, M. catarrhalis, S. aureus, and S. pneumoniae. Examples include amoxicillin/clavulanic acid, azithromycin, clarithromycin, and doxycycline. Patients with known P. aeruginosa colonization or more severe exacerbations should receive antibiotics effective against this organism (eg, ciprofloxacin, levofloxacin) until repeat culture results are available. Antibiotics should be adjusted based on culture results and are given for a typical duration of 14 days, especially if P. aeruginosa is detected. Shorter courses are reserved for patients with mild disease.

• #3 Bronchiectasis Treatment & Management: Approach Considerations, Supportive Treatment, Antibiotic Therapy

  https://emedicine.medscape.com/article/296961-treatment

  Antibiotics and chest physiotherapy are the mainstay modalities. Other modalities (beyond those for specific associated conditions) may include bronchodilators, corticosteroid therapy, dietary supplementation, and oxygen or surgical therapies. […] A crucial goal of bronchiectasis treatment is to reduce the frequency of pulmonary exacerbations. […] The following general measures are recommended: Smoking cessation, Avoidance of second-hand smoke, Adequate nutritional intake with supplementation, if necessary, Immunizations for influenza and pneumococcal pneumonia, Confirmation of immunizations for measles, rubeola, and pertussis. […] Oxygen therapy is reserved for patients who are hypoxemic with severe disease and end-stage complications, such as cor pulmonale. […] Antibiotics have been the mainstay of treatment for more than 40 years.

• #3 Are new treatments emerging for bronchiectasis? – Dr Ricardo Jose – London Chest Specialist

  https://londonchestspecialist.co.uk/2023/03/15/new-bronchiectasis-treatment/

  Bronchiectasis is a chronic lung condition characterised by abnormal and permanent widening of the bronchi (the airways that lead to the lungs), often resulting in recurrent infections and respiratory symptoms such as cough, sputum production, and shortness of breath. Although there is no cure for bronchiectasis, there are several new (emerging) treatments that will likely help manage the symptoms and improve the quality of life for people with this condition. […] Brensocatib is a new anti-inflammatory treatment that is being studied for its potential use in bronchiectasis. […] Clinical trials have shown that brensocatib reduces the frequency of exacerbations in patients with bronchiectasis. […] Currently, brensocatib is undergoing phase 3 clinical trials to further evaluate its safety and effectiveness in patients with bronchiectasis. If the results of these trials are positive, brensocatib could become a new treatment option for patients with bronchiectasis.

• #3 Airway Clearance and Bronchiectasis

  https://respiratory-therapy.com/products-treatment/monitoring-treatment/therapy-devices/airway-clearance-bronchiectasis/

  The overall goals for disease management include optimizing lung function by resolving inflammation, controlling infection, and airway clearance. […] The primary goal of this therapy is subjective and patient-specific depending on the underlying cause of the bronchiectasis. Airway clearance pertaining to bronchiectasis as a broad category is mainly for mobilization and removal of secretions always with the goal to prevent atelectasis, optimize gas exchange, and stave off infection. […] The role of the RT on a bronchiectasis care team is to employ strict bronchopulmonary hygiene efficiently and consistently and assess response to therapies by reviewing X-rays, lab work, and monitoring sputum production. […] The tailoring of treatment based on each patients unique needs is crucial in the treatment of bronchiectasis patients, and the RT plays a vital role in personalizing care.

• #3 Bronchiectasis Information | ColumbiaDoctors

  https://www.columbiadoctors.org/specialties/lung-breathing-disorders/our-services/bronchiectasis/about-bronchiectasis

  Bronchiectasis is a chronic lung condition, meaning there is currently no cure. Treatment focuses on managing symptoms and limiting flare-ups to improve quality of life. […] Bronchiectasis treatments focus on eliminating/controlling infections and clearing mucus to make it easier to breathe. Some treatments are used for daily maintenance, while others help during flare-ups. Treatment will vary based on the underlying cause. Options include: […] Current clinical trials explore new treatment options, including new medical therapies to target NTM infections. […] The outlook for people with bronchiectasis has improved dramatically over the past few decades. Working with a specialist to develop an individualized treatment can help manage symptoms and dramatically improve quality of life. […] The Bronchiectasis Center at Columbia University Irving Medical Center/NewYork-Presbyterian (CUIMC/NYP) is a leading site for comprehensive diagnosis and treatment for all types of bronchiectasis. The center uses a multidisciplinary approach to develop personalized therapy plans for each patient’s unique condition.

• #4 Medications for Bronchiectasis – Bronchiectasis

  https://bronchiectasis.com.au/bronchiectasis/medications-2/medications-for-bronchiectasis

  Patients with frequent exacerbations (3 or more exacerbations in the past year) and poor quality of life may be considered for macrolide therapy (Hill 2016). […] The optimal duration of treatment is not clear. Positive clinical trials have treated for 6 or 12 months. The maximum benefit of macrolide treatment is thought be attained after at least 3 months of treatment. Therefore treatment durations of between 3 and 12 month could be considered and some patients may require longer term treatment. […] Other targeted oral antibiotics (for example doxycycline or amoxicillin) can be considered in cases of macrolide contraindication or intolerance, however evidence for alternative antibiotic classes is limited to small historical trials showing reduced sputum purulence and less days off work with oxytetracycline and amoxicillin.

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