Treatment of Bronchiectasis

Identify and treat underlying causes.

Airway clearance techniques typically performed 1-2 times daily for
20-30 minutes and may include:
Postural drainage.
Forced expiration technique.
Positive expiratory pressure device.
Addition of noninvasive ventilation or intermittent positive pressure
breathing.
Offer manual chest percussion airway clearance techniques to patients
having acute exacerbations or if patient is very fatigued.
Airway oscillatory device might improve quality of life in adults with
bronchiectasis.
Antibiotics may be indicated for adults and children with
exacerbations and acute deterioration with worsening local
symptoms and/or systemic systems:
Obtain sputum sample prior to starting antibiotics.
Selected dosing for first-line treatment in adults includes for patients
with no previous bacteriology available:
Amoxicillin 500 mg twice daily for 14 days.
Clarithromycin 500 mg twice daily for 14 days for patients allergic to
penicillin.
Pathogen-specific antibiotic regimens vary for adults and children.
Prolonged use of antibiotics associated with improved response rates
in patients with bronchiectasis.
Use of macrolides for 2 months decreases risk of exacerbations in
adults with noncystic fibrosis bronchiectasis and may decrease risk in
children.
Long-term oral or nebulized antibiotics may be necessary for patients
having recurrent exacerbations
Offer pulmonary rehabilitation to patients with breathlessness
affecting quality of life.
Inspiratory muscle training may improve exercise capacity and quality of
life in patients with bronchiectasis.
Pulmonary rehabilitation plus inspiratory muscle training associated with
improved exercise tolerance in patients with idiopathic bronchiectasis.
Noninvasive ventilation may be considered for patients with
chronic respiratory failure to improve quality of life and reduce
number of hospitalizations.
Surgical options include
Lung resection in patients with localized disease and symptoms
refractory to medical treatment
Bronchial artery embolization or surgery for patients with massive
hemoptysis.