Medicines for Bronchiectasis

What it is

Bronchiectasis is a long-term lung condition in which the bronchi — the airways that carry air in and out of the lungs — become permanently widened, thickened and scarred. The damaged airways no longer clear themselves properly, so sticky mucus pools in them. This stagnant mucus becomes a breeding ground for bacteria, leading to a cycle of recurrent chest infections and further damage. The main symptoms are a persistent cough that brings up large amounts of phlegm, repeated chest infections, breathlessness, wheeze and tiredness; some people also cough up blood. The condition can follow a serious lung infection earlier in life, but it has many possible underlying causes — including problems with the immune system, conditions affecting mucus clearance, inhaled objects or aspiration, and other lung diseases — and in some people no cause is ever found. Identifying and treating any underlying cause is an important part of care, because it can change how the condition is managed. Bronchiectasis is usually a stable, manageable long-term condition, but flare-ups (exacerbations), when symptoms suddenly worsen and phlegm increases or changes colour, need prompt attention.

How it is treated

The cornerstone of managing bronchiectasis is daily airway clearance — physiotherapy techniques and breathing exercises that help shift the pooled mucus out of the lungs. People are usually taught these by a respiratory physiotherapist and do them every day, because keeping the airways clear reduces symptoms and helps prevent infections; staying active and well hydrated supports this. Flare-ups are treated promptly with a course of antibiotics, guided where possible by samples of phlegm so the right antibiotic is chosen, as treating exacerbations quickly limits further lung damage. For people who have frequent flare-ups, long-term antibiotics — often a macrolide taken regularly, which has a helpful effect on inflammation as well as infection — may be used under specialist supervision to reduce how often exacerbations happen. Mucoactive (mucolytic) agents and devices may be added to make the mucus easier to clear in selected people. Vaccinations, stopping smoking, treating any underlying cause, and pulmonary rehabilitation for those who are breathless all form part of overall care. Because management is individual and some treatments need specialist input, people with bronchiectasis are usually looked after with the help of a respiratory team.